Provider Demographics
NPI:1053863712
Name:ON DENTAL CORPORATION
Entity Type:Organization
Organization Name:ON DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUL
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:BYUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-556-6556
Mailing Address - Street 1:19038 NORWALK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-7032
Mailing Address - Country:US
Mailing Address - Phone:714-556-6556
Mailing Address - Fax:
Practice Address - Street 1:19038 NORWALK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-7032
Practice Address - Country:US
Practice Address - Phone:714-556-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty