Provider Demographics
NPI:1134462823
Name:CLAREMONT SERENITY DENTISTRY
Entity Type:Organization
Organization Name:CLAREMONT SERENITY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAEZ DDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-398-4800
Mailing Address - Street 1:410 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1607
Mailing Address - Country:US
Mailing Address - Phone:909-398-4800
Mailing Address - Fax:909-398-4900
Practice Address - Street 1:410 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1607
Practice Address - Country:US
Practice Address - Phone:909-398-4800
Practice Address - Fax:909-398-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560021223G0001X
CA577241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty