MEDICARE: FRANCISCO C ENVERGA DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255897617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANCISCO C ENVERGA DDS, INC.

Provider Business Mailing Address
First Line	:	2508 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6253
Country	:	US
Telephone Number	:	909-923-7881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 S GROVE AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6253
Country	:	US
Telephone Number	:	909-923-7881
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. FRANCISCO C ENVERGA
Credential	:	DDS
Telephone Number	:	909-923-7881

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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