| Packing House District Dental & Orthodontics | |
|
720 Magnolia Ave Ste A1 Corona CA 92879-3119 | |
| (951) 737-3800 | |
| (951) 737-3937 |
| Full Name | Packing House District Dental & Orthodontics |
|---|---|
| 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 |
|---|---|
| Packing House District Dental & Orthodontics 400 W Stuart Ave Ste 110 Redlands CA 92374-3129 Ph: (909) 793-1595 | Packing House District Dental & Orthodontics 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 |
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