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General NPI Number Information
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NPI Number | 1992824270
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Entity Type | Organization
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Legal Business Name | OAK VALLEY FAMILY DENTAL
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1037 BEAUMONT AVE
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City | BEAUMONT
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State | CA
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Zip | 92223-1832
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Country | US
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Telephone | 951-769-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 BEAUMONT AVE
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City | BEAUMONT
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State | CA
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Zip | 92223-1832
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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 | GENERAL PARTNER
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Name | DR. ANDREA LEWIS
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Credential |
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Telephone | 951-769-7797
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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 | 54279
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License Number State | CA
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