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General NPI Number Information
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NPI Number | 1497080246
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Entity Type | Organization
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Legal Business Name | EZE DENTAL COPORATION
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 121 W FOOTHILL BLVD SUITE E
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City | UPLAND
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State | CA
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Zip | 91786-3890
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Country | US
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Telephone | 909-982-9800
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Fax | 888-741-6009
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Provider Business Mailing Address
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Address Line | 121 W FOOTHILL BLVD SUITE E
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City | UPLAND
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State | CA
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Zip | 91786-3890
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Country | US
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Telephone | 909-982-9800
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Fax | 888-741-6009
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Authorized Official
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Title or Position | CEO
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Name | DR. KENECHUKWU EZE
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Credential | D.D.S
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Telephone | 909-982-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56954
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License Number State | CA
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