| Marvin E. Ota, Dds | |
|
11834 Bryant St Suite 103 Yucaipa CA 92399-3815 | |
| (909) 797-8090 | |
| Not Available |
| Full Name | Marvin E. Ota, Dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11834 Bryant St, Yucaipa, California |
| Authorized Official Name and Position | Marvin Eiji Ota (OWNER) |
| Authorized Official Contact | 9097978090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marvin E. Ota, Dds 11834 Bryant St Suite 103 Yucaipa CA 92399-3815 Ph: (909) 797-8090 | Marvin E. Ota, Dds 11834 Bryant St Suite 103 Yucaipa CA 92399-3815 Ph: (909) 797-8090 |
| NPI Number | 1699901082 |
|---|---|
| Provider Enumeration Date | 05/31/2009 |
| Last Update Date | 05/31/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699901082 | NPI | - | NPPES |
| B28214-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 28214 (California) | Primary |
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