Provider Demographics
NPI:1376722595
Name:PRINCESITA A. BILLEDO D.D.S., INC
Entity Type:Organization
Organization Name:PRINCESITA A. BILLEDO D.D.S., INC
Other - Org Name:MOUNTAIN DENTAL FITNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCESITA
Authorized Official - Middle Name:ASUNCION
Authorized Official - Last Name:BILLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-460-7776
Mailing Address - Street 1:1755 S MOUNTAIN AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5972
Mailing Address - Country:US
Mailing Address - Phone:909-460-7776
Mailing Address - Fax:909-460-7677
Practice Address - Street 1:1755 S MOUNTAIN AVE
Practice Address - Street 2:STE. A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5972
Practice Address - Country:US
Practice Address - Phone:909-460-7776
Practice Address - Fax:909-460-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty