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13768 Roswell Ave Suite # 221 Chino CA 91710-1401 | |
| (909) 548-6828 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 13768 Roswell Ave, Chino, California |
| Authorized Official Name and Position | Johnny K Ma (PRESIDENT) |
| Authorized Official Contact | 9095486828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13768 Roswell Ave Suite # 221 Chino CA 91710-1401 Ph: (909) 548-6828 | 13768 Roswell Ave Suite # 221 Chino CA 91710-1401 Ph: (909) 548-6828 |
| NPI Number | 1366886897 |
|---|---|
| Provider Enumeration Date | 04/26/2013 |
| Last Update Date | 04/26/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366886897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 51855 (California) | Primary |
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