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General NPI Number Information
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NPI Number | 1558761296
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Entity Type | Organization
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Legal Business Name | CUSCATLAN DENTAL CENTER
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 1357 S EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-5815
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Country | US
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Telephone | 909-635-3738
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Fax | 909-635-3736
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Provider Business Mailing Address
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Address Line | 1357 S EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-5815
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Country | US
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Telephone | 909-635-3738
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Fax | 909-635-3736
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Authorized Official
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Title or Position | MANAGER
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Name | MAY EVELYN CRUZ
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Credential | DDS
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Telephone | 909-802-3201
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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 | 43134
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License Number State | CA
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