Provider Demographics
NPI:1083296941
Name:DR RUSEN EMPIRE FRIENDLY SMILES DENTAL INC
Entity Type:Organization
Organization Name:DR RUSEN EMPIRE FRIENDLY SMILES DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RARES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-799-8200
Mailing Address - Street 1:1078 E HOSPITALITY LN STE A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2863
Mailing Address - Country:US
Mailing Address - Phone:909-799-8200
Mailing Address - Fax:
Practice Address - Street 1:1078 E HOSPITALITY LN STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2863
Practice Address - Country:US
Practice Address - Phone:909-799-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty