Provider Demographics
NPI:1174610638
Name:LOUIS STROMBERG PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:LOUIS STROMBERG PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:Z
Authorized Official - Last Name:STROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-985-2302
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:1875 N CAMPUS AVE
Practice Address - Street 2:STE. C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-8208
Practice Address - Country:US
Practice Address - Phone:909-985-2302
Practice Address - Fax:909-982-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty