| Yucaipa Family Dental | |
|
11834 Bryant St Ste 102 Yucaipa CA 92399-3848 | |
| (909) 797-8090 | |
| (909) 918-0595 |
| Full Name | Yucaipa Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 11834 Bryant St Ste 102, Yucaipa, California |
| Authorized Official Name and Position | Richard S. Lim (OWNER CEO) |
| Authorized Official Contact | 9097978090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Yucaipa Family Dental 11834 Bryant St Ste 102 Yucaipa CA 92399-3848 Ph: (909) 797-8090 | Yucaipa Family Dental 11834 Bryant St Ste 102 Yucaipa CA 92399-3848 Ph: (909) 797-8090 |
| NPI Number | 1497146872 |
|---|---|
| Provider Enumeration Date | 02/06/2015 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497146872 | NPI | - | NPPES |
| 1962842575 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 62480 (California) | Primary |
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