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25906 Newport Rd Ste 101 Menifee CA 92584-9130 | |
| (951) 672-1666 | |
| (855) 895-3627 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 25906 Newport Rd Ste 101, Menifee, California |
| Authorized Official Name and Position | Ryan B Baker (OWNER) |
| Authorized Official Contact | 8584058434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
25906 Newport Rd Ste 101 Menifee CA 92584-9130 Ph: (951) 672-1666 | 25906 Newport Rd Ste 101 Menifee CA 92584-9130 Ph: (951) 672-1666 |
| NPI Number | 1598268849 |
|---|---|
| Provider Enumeration Date | 03/13/2018 |
| Last Update Date | 11/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598268849 | NPI | - | NPPES |
| 1598268849 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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