| Rita T. Deragobian Dds, Inc. | |
|
1435 E Route 66 Ste D Glendora CA 91740-3748 | |
| (626) 914-3900 | |
| (626) 914-0019 |
| Full Name | Rita T. Deragobian Dds, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 1435 E Route 66 Ste D, Glendora, California |
| Authorized Official Name and Position | Rita Deragobian (DENTIST/OWNER) |
| Authorized Official Contact | 6269143900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rita T. Deragobian Dds, Inc. 1435 E Route 66 Ste D Glendora CA 91740-3748 Ph: (626) 914-3900 | Rita T. Deragobian Dds, Inc. 1435 E Route 66 Ste D Glendora CA 91740-3748 Ph: (626) 914-3900 |
| NPI Number | 1295227288 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 01/08/2020 |
| Medicare PECOS PAC ID | 8224361944 |
|---|---|
| Medicare Enrollment ID | O20190612002552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295227288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | 55480 (California) | Secondary |
| Provider Name | Rita Deragobian |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1578742953 PECOS PAC ID: 5496056939 Enrollment ID: I20190613000237 |
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