| Grand Avenue Dental Practice | |
|
1249 North Grand Ave Walnut CA 91789 | |
| (909) 444-9488 | |
| (909) 444-9788 |
| Full Name | Grand Avenue Dental Practice |
|---|---|
| Speciality | Dentist |
| Location | 1249 North Grand Ave, Walnut, California |
| Authorized Official Name and Position | Robert Mari Guerrero Ramos (PRESIDENT) |
| Authorized Official Contact | 9094449488 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Avenue Dental Practice 1249 North Grand Ave Walnut CA 91789 Ph: (909) 444-9488 | Grand Avenue Dental Practice 1249 North Grand Ave Walnut CA 91789 Ph: (909) 444-9488 |
| NPI Number | 1114133824 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 01/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114133824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 49397 (California) | Primary |
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