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General NPI Number Information
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NPI Number | 1952291593
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Entity Type | Organization
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Legal Business Name | GRAND TERRACE MODERN DENTISTRY, INC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 22471 BARTON RD
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5008
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Country | US
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Telephone | 909-657-9498
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER WALTERS
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Credential |
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Telephone | 714-845-8500
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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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