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695 W Highland Ave San Bernardino CA 92405-3812 | |
| (909) 881-2545 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 695 W Highland Ave, San Bernardino, California |
| Authorized Official Name and Position | David Kutner (PRESIDENT) |
| Authorized Official Contact | 6264424582 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
695 W Highland Ave San Bernardino CA 92405-3812 Ph: (909) 881-2545 | 695 W Highland Ave San Bernardino CA 92405-3812 Ph: (909) 881-2545 |
| NPI Number | 1992950281 |
|---|---|
| Provider Enumeration Date | 12/01/2008 |
| Last Update Date | 12/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992950281 | NPI | - | NPPES |
| 1174714547 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 27016 (California) | Primary |
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