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General NPI Number Information
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NPI Number | 1477928992
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Entity Type | Organization
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Legal Business Name | HALF DENTAL RANCHO CUCAMONGA INC
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 8906 SAN BERNARDINO RD SUITE 130
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8805
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Country | US
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Telephone | 909-576-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 915 W FOOTHILL BLVD # C292
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City | CLAREMONT
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State | CA
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Zip | 91711-3356
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Country | US
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Telephone | 909-576-3999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT JAMES HOUCHIN
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Credential | DDS
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Telephone | 909-576-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28166
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License Number State | CA
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