Provider Demographics
NPI:1033325147
Name:CALICDAN-STA.ANA DDS CORP
Entity Type:Organization
Organization Name:CALICDAN-STA.ANA DDS CORP
Other - Org Name:MOUNT HILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALICDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-981-5083
Mailing Address - Street 1:1227 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3681
Mailing Address - Country:US
Mailing Address - Phone:909-981-5083
Mailing Address - Fax:909-981-4213
Practice Address - Street 1:1227 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3681
Practice Address - Country:US
Practice Address - Phone:909-981-5083
Practice Address - Fax:909-981-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty