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4110 Edison Ave 107-b Chino CA 91710-8409 | |
| (909) 536-1900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4110 Edison Ave, Chino, California |
| Authorized Official Name and Position | Anisha Sudan (OWNER) |
| Authorized Official Contact | 9095361900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4110 Edison Ave 107-b Chino CA 91710-8409 Ph: () - | 4110 Edison Ave 107-b Chino CA 91710-8409 Ph: (909) 536-1900 |
| NPI Number | 1912441148 |
|---|---|
| Provider Enumeration Date | 12/07/2016 |
| Last Update Date | 12/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912441148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 60267 (California) | Primary |
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