Provider Demographics
NPI:1003084229
Name:DANIEL DUROSEAU DDS INC
Entity Type:Organization
Organization Name:DANIEL DUROSEAU DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUROSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-204-3651
Mailing Address - Street 1:126 W B ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3503
Mailing Address - Country:US
Mailing Address - Phone:909-984-4746
Mailing Address - Fax:909-984-4414
Practice Address - Street 1:270 E 7TH ST STE 2D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6602
Practice Address - Country:US
Practice Address - Phone:909-608-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48452122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty