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General NPI Number Information
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NPI Number | 1578758967
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Entity Type | Organization
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Legal Business Name | MUENI L. MUTINGA D.D.S. DENTAL CORPORATION
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 3701 MARKET ST SUITE E
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City | RIVERSIDE
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State | CA
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Zip | 92501-3250
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Country | US
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Telephone | 951-786-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 MARKET ST SUITE E
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City | RIVERSIDE
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State | CA
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Zip | 92501-3250
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Country | US
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Telephone | 951-786-9600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MUENI LORRAINE MUTINGA
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Credential | D.D.S.
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Telephone | 909-810-9930
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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 | 48518
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License Number State | CA
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