Provider Demographics
NPI:1093027286
Name:CHIA, LUCIA MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:MARIA
Last Name:CHIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 E E ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4200
Mailing Address - Country:US
Mailing Address - Phone:909-986-1003
Mailing Address - Fax:909-986-1091
Practice Address - Street 1:647 E E ST STE 103
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4200
Practice Address - Country:US
Practice Address - Phone:909-986-1003
Practice Address - Fax:909-986-1091
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG930701OtherDENTI-CAL