| Citrus Grove Dental | |
|
2520 E Workman Ave West Covina CA 91791-1534 | |
| (626) 966-0300 | |
| (696) 966-0336 |
| Full Name | Citrus Grove Dental |
|---|---|
| Speciality | Dentist |
| Location | 2520 E Workman Ave, West Covina, California |
| Authorized Official Name and Position | Yintawati Satyarahardja (PRESIDENT) |
| Authorized Official Contact | 6269660300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Citrus Grove Dental 2520 E Workman Ave West Covina CA 91791-1534 Ph: (626) 966-0300 | Citrus Grove Dental 2520 E Workman Ave West Covina CA 91791-1534 Ph: (626) 966-0300 |
| NPI Number | 1508296450 |
|---|---|
| Provider Enumeration Date | 11/13/2013 |
| Last Update Date | 11/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508296450 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 46955 (California) | Primary |
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