Provider Demographics
NPI:1437406873
Name:CARING FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CARING FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MIEUN
Authorized Official - Last Name:PARK-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-888-5499
Mailing Address - Street 1:1063 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3539
Mailing Address - Country:US
Mailing Address - Phone:909-888-5499
Mailing Address - Fax:909-888-5611
Practice Address - Street 1:1063 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3539
Practice Address - Country:US
Practice Address - Phone:909-888-5499
Practice Address - Fax:909-888-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40976122300000X
CA36091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9164701OtherDENTI-CAL