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4036 Grand Ave Suite D Chino CA 91710-5487 | |
| (909) 627-9996 | |
| (909) 517-1035 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4036 Grand Ave, Chino, California |
| Authorized Official Name and Position | Fenny Virgin (PRESIDENT) |
| Authorized Official Contact | 9096279996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4036 Grand Ave Suite D Chino CA 91710-5487 Ph: (909) 627-9996 | 4036 Grand Ave Suite D Chino CA 91710-5487 Ph: (909) 627-9996 |
| NPI Number | 1285183194 |
|---|---|
| Provider Enumeration Date | 10/04/2016 |
| Last Update Date | 10/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285183194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (California) | Primary |
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