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General NPI Number Information
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NPI Number | 1508021924
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Entity Type | Organization
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Legal Business Name | DENTAL HEALTH RIVERSIDE
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 6339 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2031
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Country | US
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Telephone | 951-369-3597
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Fax | 951-369-0487
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Provider Business Mailing Address
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Address Line | 6339 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2031
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Country | US
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Telephone | 951-369-3597
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Fax | 951-369-0487
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Authorized Official
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Title or Position | AREA MANAGER
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Name | MRS. LETICIA VALENZUELA
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Credential |
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Telephone | 951-369-3597
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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 | 53592
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License Number State | CA
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