Provider Demographics
NPI:1013414200
Name:REMONA DENTAL CENTER INC.
Entity Type:Organization
Organization Name:REMONA DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HADI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUSUMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-625-3600
Mailing Address - Street 1:324 S INDIAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5289
Mailing Address - Country:US
Mailing Address - Phone:909-625-3600
Mailing Address - Fax:
Practice Address - Street 1:324 S INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5289
Practice Address - Country:US
Practice Address - Phone:909-625-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty