Provider Demographics
NPI:1073158564
Name:NGUYEN TABARI DENTAL INC
Entity Type:Organization
Organization Name:NGUYEN TABARI DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFINBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-987-8835
Mailing Address - Street 1:10630 TOWN CENTER DR STE 131
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8600
Mailing Address - Country:US
Mailing Address - Phone:909-987-8835
Mailing Address - Fax:909-484-3101
Practice Address - Street 1:10630 TOWN CENTER DR STE 131
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8600
Practice Address - Country:US
Practice Address - Phone:909-987-8835
Practice Address - Fax:909-484-3101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NGUYEN TABARI DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental