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General NPI Number Information
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NPI Number | 1629637376
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Entity Type | Organization
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Legal Business Name | AESTHETIC DENTAL GROUP INC
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 415 W ROUTE 66 STE 201
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City | GLENDORA
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State | CA
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Zip | 91740-4335
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Country | US
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Telephone | 626-914-0020
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Fax | 626-914-0023
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Provider Business Mailing Address
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Address Line | 415 W ROUTE 66 STE 201
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City | GLENDORA
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State | CA
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Zip | 91740-4335
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Country | US
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Telephone | 626-914-0020
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Fax | 626-914-0023
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Authorized Official
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Title or Position | DENTIST
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Name | WILLIAM J ROUHANA
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Credential |
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Telephone | 626-914-0020
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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 |
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License Number State |
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