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111 W Holt Blvd Ontario CA 91762-3823 | |
| (909) 933-6800 | |
| (909) 933-6801 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 111 W Holt Blvd, Ontario, California |
| Authorized Official Name and Position | Ana V Rios (PRESIDENT) |
| Authorized Official Contact | 9099336800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
111 W Holt Blvd Ontario CA 91762-3823 Ph: (909) 933-6800 | 111 W Holt Blvd Ontario CA 91762-3823 Ph: (909) 933-6800 |
| NPI Number | 1619346202 |
|---|---|
| Provider Enumeration Date | 09/24/2015 |
| Last Update Date | 09/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619346202 | NPI | - | NPPES |
| 1730245218 | Other | CA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 45965 (California) | Primary |
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