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216 E Route 66 Glendora CA 91740-6241 | |
| (626) 335-0134 | |
| (626) 335-1140 |
| Full Name | |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 216 E Route 66, Glendora, California |
| Authorized Official Name and Position | Michael Henriod (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8017927018 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
216 E Route 66 Glendora CA 91740-6241 Ph: (626) 335-0134 | 216 E Route 66 Glendora CA 91740-6241 Ph: (626) 335-0134 |
| NPI Number | 1750814612 |
|---|---|
| Provider Enumeration Date | 04/07/2017 |
| Last Update Date | 04/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750814612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 55124 (California) | Primary |
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