Provider Demographics
NPI:1861750291
Name:CENTAL DENTAL
Entity type:Organization
Organization Name:CENTAL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-383-7777
Mailing Address - Street 1:222 N G ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3217
Mailing Address - Country:US
Mailing Address - Phone:909-383-7777
Mailing Address - Fax:909-383-7779
Practice Address - Street 1:222 N G ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3217
Practice Address - Country:US
Practice Address - Phone:909-383-7777
Practice Address - Fax:909-383-7779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty