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720 Magnolia Ave Ste A1 Corona CA 92879-3119 | |
| (951) 737-3800 | |
| (951) 737-3937 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 720 Magnolia Ave Ste A1, Corona, California |
| Authorized Official Name and Position | Homer Ketcherside (PRESIDENT) |
| Authorized Official Contact | 9098107167 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
400 W Stuart Ave Ste 110 Redlands CA 92374-3129 Ph: (909) 793-1595 | 720 Magnolia Ave Ste A1 Corona CA 92879-3119 Ph: (951) 737-3800 |
| NPI Number | 1629557517 |
|---|---|
| Provider Enumeration Date | 08/10/2018 |
| Last Update Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629557517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 28872 (California) | Primary |
Kawata And Matsumoto Specialists In Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 854 Magnolia Ave, Suite A, Corona, CA 92879 Phone: 951-736-7846 Fax: 951-736-7862 | |
Vasoya Dipakkumar Dds Pc Dental Clinic Medicare: Medicare Enrolled Practice Location: 301 W 6th St Ste 105, Corona, CA 92882 Phone: 951-258-1407 | |
Parkridge Dental Spa Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 E Parkridge Ave, Corona, CA 92879 Phone: 951-735-0200 Fax: 951-735-0203 |