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General NPI Number Information
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NPI Number | 1922433531
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE DENTAL SPECIALTY GROUP
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 415 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4609
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Country | US
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Telephone | 909-792-8440
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Fax | 909-792-9694
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Provider Business Mailing Address
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Address Line | 415 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4609
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Country | US
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Telephone | 909-792-8440
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Fax | 909-792-9694
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. PETER CHO
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Credential | DDS
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Telephone | 909-792-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 50740
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License Number State | CA
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