Provider Demographics
NPI:1376197954
Name:PURECO DENTAL GROUP INC
Entity Type:Organization
Organization Name:PURECO DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PURECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-256-0090
Mailing Address - Street 1:485 E FOOTHILL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3987
Mailing Address - Country:US
Mailing Address - Phone:909-256-0090
Mailing Address - Fax:909-256-0092
Practice Address - Street 1:485 E FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3987
Practice Address - Country:US
Practice Address - Phone:909-256-0090
Practice Address - Fax:909-256-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental