| Signature Dental Group | |
|
1183 E Foothill Blvd Unit 240 Upland CA 91786-4049 | |
| (909) 981-6882 | |
| (909) 981-0276 |
| Full Name | Signature Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 1183 E Foothill Blvd, Upland, California |
| Authorized Official Name and Position | Jason S Lee (CEO) |
| Authorized Official Contact | 9099108282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Signature Dental Group 1183 E Foothill Blvd Unit 240 Upland CA 91786-4049 Ph: (909) 981-6882 | Signature Dental Group 1183 E Foothill Blvd Unit 240 Upland CA 91786-4049 Ph: (909) 981-6882 |
| NPI Number | 1912052978 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 12/28/2008 |
| Medicare PECOS PAC ID | 6507193687 |
|---|---|
| Medicare Enrollment ID | O20190813000275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912052978 | NPI | - | NPPES |
| G98378-01 | Other | CA | DELTA HEALTHY FAMILY |
| 01604010 | Other | CA | UNITED CONCORDIA NUMBER |
| 247386 | Other | CA | DELTA DENTAL # FOR UPLAND |
| G93055-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Jason Lee |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528112257 PECOS PAC ID: 3173842358 Enrollment ID: I20190814000301 |
| Provider Name | Fiona C Chan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1942352703 PECOS PAC ID: 2668792201 Enrollment ID: I20190814000504 |
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