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General NPI Number Information
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NPI Number | 1780708768
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Entity Type | Organization
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Legal Business Name | ASSISTANCE LEAGUE OF SAN BERNARDINO
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 580 W 6TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3002
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Country | US
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Telephone | 909-885-2045
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Fax | 909-885-5900
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Provider Business Mailing Address
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Address Line | 580 W 6TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3002
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Country | US
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Telephone | 909-885-2045
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Fax | 909-885-5900
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Authorized Official
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Title or Position | CHAIR, DR. EARL R. CRANE CHILDREN'S
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Name | DR. CHERYL FULTON FISCHER
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Credential | PH.D.
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Telephone | 909-885-2045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 54145
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License Number State | CA
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