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General NPI Number Information
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NPI Number | 1679620439
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Entity Type | Organization
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Legal Business Name | VILLAMOR R. USITA, D.D.S., INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 11010 FOOTHILL BLVD STE. 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7616
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Country | US
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Telephone | 909-481-8881
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Fax | 909-481-7722
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Provider Business Mailing Address
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Address Line | 11010 FOOTHILL BLVD STE. 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7616
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Country | US
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Telephone | 909-481-8881
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Fax | 909-481-7722
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | DR. VILLAMOR RIALUBIN USITA
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Credential | D.D.S.
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Telephone | 909-481-8881
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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 | 43504
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License Number State | CA
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