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General NPI Number Information
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NPI Number | 1932066644
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Entity Type | Organization
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Legal Business Name | JURUPA VALLEY DENTAL GROUP, INC.
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 6348 MISSION BLVD, UNIT 106
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City | JURUPA VALLEY
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State | CA
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Zip | 92509
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Country | US
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Telephone | 951-592-3453
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Fax | 951-335-8218
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Provider Business Mailing Address
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Address Line | PO BOX 660041
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City | DALLAS
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State | TX
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Zip | 75266-0041
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | CASEY LA
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Credential | DMD
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Telephone | 951-592-3453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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