| Ecco Detnal | |
|
1753 S Valley Center Ave Glendora CA 91740-6100 | |
| (626) 771-0064 | |
| (626) 513-7463 |
| Full Name | Ecco Detnal |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1753 S Valley Center Ave, Glendora, California |
| Authorized Official Name and Position | German Guillermo Jaquez (DENTIST) |
| Authorized Official Contact | 6267710064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ecco Detnal 1753 S Valley Center Ave Glendora CA 91740-6100 Ph: (626) 771-0064 | Ecco Detnal 1753 S Valley Center Ave Glendora CA 91740-6100 Ph: (626) 771-0064 |
| NPI Number | 1033979430 |
|---|---|
| Provider Enumeration Date | 03/21/2024 |
| Last Update Date | 04/05/2024 |
| Certification Date | 04/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033979430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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