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166 E Main St #6 San Jacinto CA 92583-4200 | |
| (951) 654-8005 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 166 E Main St, San Jacinto, California |
| Authorized Official Name and Position | Kenvis Ngow (DENTIST) |
| Authorized Official Contact | 9516549700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
166 E Main St #6 San Jacinto CA 92583-4200 Ph: (951) 654-8005 | 166 E Main St #6 San Jacinto CA 92583-4200 Ph: (951) 654-8005 |
| NPI Number | 1598942831 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 01/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598942831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 48753 (California) | Primary |
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San Jacinto Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 W Esplanade Ave, Ste K, San Jacinto, CA 92582 Phone: 951-654-3424 Fax: 951-654-9423 |