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General NPI Number Information
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NPI Number | 1780089938
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Entity Type | Organization
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Legal Business Name | TODD EHRLER PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 14976 FOOTHILL BLVD SUITE 100
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City | FONTANA
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State | CA
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Zip | 92335-7045
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Country | US
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Telephone | 909-350-8730
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Fax | 909-350-8733
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Provider Business Mailing Address
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Address Line | 14976 FOOTHILL BLVD SUITE 100
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City | FONTANA
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State | CA
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Zip | 92335-7045
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Country | US
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Telephone | 909-350-8730
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Fax | 909-350-8733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD BRIAN EHRLER
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Credential | DDS
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Telephone | 909-851-2541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 49748
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License Number State | CA
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