Provider Demographics
NPI:1265853782
Name:DR. EARL R. CRANE CHILDREN'S DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:DR. EARL R. CRANE CHILDREN'S DENTAL HEALTH CENTER
Other - Org Name:CHILDREN'S DENTAL BENEFIT ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTAL CENTER CHAIR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:909-227-8980
Mailing Address - Street 1:580 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3002
Mailing Address - Country:US
Mailing Address - Phone:909-885-2045
Mailing Address - Fax:909-885-5900
Practice Address - Street 1:580 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3002
Practice Address - Country:US
Practice Address - Phone:909-885-2045
Practice Address - Fax:909-885-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable