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General NPI Number Information
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NPI Number | 1962888446
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Entity Type | Organization
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Legal Business Name | LEMOS & SANDOVAL DENTAL CORPORATION
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 18790 VALLEY BLVD SUITE D
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City | BLOOMINGTON
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State | CA
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Zip | 92316-2241
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Country | US
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Telephone | 909-873-5093
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Fax |
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Provider Business Mailing Address
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Address Line | 18790 VALLEY BLVD SUITE D
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City | BLOOMINGTON
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State | CA
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Zip | 92316-2241
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Country | US
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Telephone | 909-873-5093
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST / C.E.O.
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Name | DR. LUIS FERNANDO LEMOS
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Credential | D.D.S
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Telephone | 909-435-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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