| Ontario Chino Dental Center | |
|
203 W. Francis Street Ontario CA 91762 | |
| (909) 984-2476 | |
| (909) 984-2003 |
| Full Name | Ontario Chino Dental Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 203 W. Francis Street, Ontario, California |
| Authorized Official Name and Position | Krupakar Yeturu (OWNER) |
| Authorized Official Contact | 9099842476 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ontario Chino Dental Center 203 W. Francis Street Ontario CA 91762 Ph: (909) 984-2476 | Ontario Chino Dental Center 203 W. Francis Street Ontario CA 91762 Ph: (909) 984-2476 |
| NPI Number | 1306194154 |
|---|---|
| Provider Enumeration Date | 08/28/2012 |
| Last Update Date | 06/29/2015 |
| Medicare PECOS PAC ID | 9537470653 |
|---|---|
| Medicare Enrollment ID | O20150616002237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306194154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 33417 (California) | Primary |
| Provider Name | Krupakar Yeturu |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1932220522 PECOS PAC ID: 0446561567 Enrollment ID: I20150819008198 |
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