Provider Demographics
NPI:1437748670
Name:WELEBIR DENTAL CORPORATION
Entity Type:Organization
Organization Name:WELEBIR DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PAYER CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-308-9792
Mailing Address - Street 1:25455 BARTON RD STE 203B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3130
Mailing Address - Country:US
Mailing Address - Phone:909-588-6468
Mailing Address - Fax:
Practice Address - Street 1:25455 BARTON RD STE 203B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3130
Practice Address - Country:US
Practice Address - Phone:909-588-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELEBIR DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty