| Plaza Dental Office | |
|
1120 Via Verde San Dimas CA 91773 | |
| (909) 599-2444 | |
| (909) 599-2024 |
| Full Name | Plaza Dental Office |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1120 Via Verde, San Dimas, California |
| Authorized Official Name and Position | Adriana Thomas (PRESIDENT OWNER) |
| Authorized Official Contact | 9095942444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Plaza Dental Office 1120 Via Verde San Dimas CA 91773 Ph: (909) 599-2444 | Plaza Dental Office 1120 Via Verde San Dimas CA 91773 Ph: (909) 599-2444 |
| NPI Number | 1114136827 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 06/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114136827 | NPI | - | NPPES |
| F9179901 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 34296 (California) | Primary |
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