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General NPI Number Information
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NPI Number | 1750730420
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Entity Type | Organization
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Legal Business Name | CLAREMONT DESIGN DENTISTRY
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 1601 MONTE VISTA AVENUE SUITE 210
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City | CLAREMONT
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State | CA
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Zip | 91711-0000
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Country | US
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Telephone | 909-981-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 MONTE VISTA AVE SUITE 210
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City | CLAREMONT
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State | CA
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Zip | 91711-2962
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Country | US
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Telephone | 909-946-2222
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Fax | 909-946-7272
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Authorized Official
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Title or Position | OWNER
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Name | RAMI JEKKI
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Credential | DDS
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Telephone | 909-946-2222
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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 | 55236
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61322
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License Number State | CA
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