=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790943470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISABELLA PIEDRA PROFESSIONAL DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 490 S FARRELL DR STE C101
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-7962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-320-7621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 920 MELBURY CT
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-6322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-499-9093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ISABELLA PIEDRA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 909-499-9093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 47307
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------