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General NPI Number Information
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NPI Number | 1851167373
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Entity Type | Organization
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Legal Business Name | DENTIQUE
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 16960 BASTANCHURY RD STE B
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City | YORBA LINDA
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State | CA
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Zip | 92886-1711
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Country | US
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Telephone | 412-639-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 4377 OCEAN VIEW BLVD
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City | MONTROSE
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State | CA
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Zip | 91020-1275
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Country | US
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Telephone | 412-639-2666
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHERYL EUNU KIM
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Credential | DMD
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Telephone | 412-639-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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