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General NPI Number Information
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NPI Number | 1548445463
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Entity Type | Organization
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Legal Business Name | JERRY L KRONQUIST SUNSET DENTAL GROUP INC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 1906 N BROADWAY
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City | SANTA ANA
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State | CA
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Zip | 92706-2610
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Country | US
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Telephone | 714-547-6671
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Fax | 714-547-4385
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Provider Business Mailing Address
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Address Line | 1906 N BROADWAY
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City | SANTA ANA
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State | CA
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Zip | 92706-2610
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Country | US
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Telephone | 714-547-6671
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Fax | 714-547-4385
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JERRY LEE KRONQUIST
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Credential |
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Telephone | 171-454-7667
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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 | 30388
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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