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7210 Day Creek Blvd Suite 110 Rancho Cucamonga CA 91739 | |
| (310) 820-9933 | |
| (310) 820-0408 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 7210 Day Creek Blvd, Rancho Cucamonga, California |
| Authorized Official Name and Position | Miguel Reyes (Q/A CONTRACT & COMPLIANCE MANAGER) |
| Authorized Official Contact | 3108209933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12121 Wilshire Blvd Ste 1111 Los Angeles CA 90025-1188 Ph: (310) 820-9933 | 7210 Day Creek Blvd Suite 110 Rancho Cucamonga CA 91739 Ph: (310) 820-9933 |
| NPI Number | 1306348768 |
|---|---|
| Provider Enumeration Date | 03/01/2018 |
| Last Update Date | 07/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306348768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 39862 (California) | Primary |
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