Provider Demographics
NPI:1407273030
Name:CORNERSTONE DENTAL CARE INC
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL CARE INC
Other - Org Name:CORNERSTONE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:SANG
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-820-9454
Mailing Address - Street 1:2836 W RIALTO AVE
Mailing Address - Street 2:# A
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6816
Mailing Address - Country:US
Mailing Address - Phone:909-820-9454
Mailing Address - Fax:909-820-9482
Practice Address - Street 1:2836 W RIALTO AVE
Practice Address - Street 2:# A
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6816
Practice Address - Country:US
Practice Address - Phone:909-820-9454
Practice Address - Fax:909-820-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty