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12411 Central Ave Chino CA 91710-2604 | |
| (909) 591-8895 | |
| (909) 591-3503 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12411 Central Ave, Chino, California |
| Authorized Official Name and Position | Tracy D Ngo (PRESIDENT) |
| Authorized Official Contact | 9095918895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12411 Central Ave Chino CA 91710-2604 Ph: (909) 591-8895 | 12411 Central Ave Chino CA 91710-2604 Ph: (909) 591-8895 |
| NPI Number | 1194907196 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 03/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194907196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 41120 (California) | Primary |
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