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General NPI Number Information
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NPI Number | 1528487634
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Entity Type | Organization
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Legal Business Name | JEFFREY DHARMAWAN DDS.INC
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 190 W H ST SUITE 100
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-825-1155
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Fax | 909-825-0275
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Provider Business Mailing Address
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Address Line | 190 W H ST STE 100
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City | COLTON
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State | CA
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Zip | 92324-2937
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Country | US
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Telephone | 909-825-1155
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Fax | 909-825-0275
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Authorized Official
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Title or Position | DENTIST
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Name | JEFFREY DHARMAWAN
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Credential | DDS
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Telephone | 909-825-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 33276
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License Number State | CA
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