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General NPI Number Information
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NPI Number | 1700050507
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Entity Type | Organization
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Legal Business Name | ANTHONY W. DEZA D.D.S.,INC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 850 W HIGHLAND AVE STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3855
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Country | US
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Telephone | 909-886-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 850 W HIGHLAND AVE STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3855
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Country | US
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Telephone |
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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. ANTHONY W DEZA
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Credential |
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Telephone | 909-886-4004
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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 | 42539
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License Number State | CA
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