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9203 Archibald Ave Rancho Cucamonga CA 91730-5207 | |
| (909) 941-2288 | |
| (909) 941-6688 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9203 Archibald Ave, Rancho Cucamonga, California |
| Authorized Official Name and Position | Pinky Del Fierro Penalosa (PRESIDENT) |
| Authorized Official Contact | 9099412288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9203 Archibald Ave Rancho Cucamonga CA 91730-5207 Ph: (909) 941-2288 | 9203 Archibald Ave Rancho Cucamonga CA 91730-5207 Ph: (909) 941-2288 |
| NPI Number | 1295225753 |
|---|---|
| Provider Enumeration Date | 05/10/2018 |
| Last Update Date | 05/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295225753 | NPI | - | NPPES |
| 1275654741 | Other | CA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DDS52769 (California) | Primary |
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