Provider Demographics
NPI:1477928992
Name:HALF DENTAL RANCHO CUCAMONGA INC
Entity Type:Organization
Organization Name:HALF DENTAL RANCHO CUCAMONGA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-576-3999
Mailing Address - Street 1:915 W FOOTHILL BLVD # C292
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3356
Mailing Address - Country:US
Mailing Address - Phone:909-576-3999
Mailing Address - Fax:
Practice Address - Street 1:8906 SAN BERNARDINO RD
Practice Address - Street 2:SUITE 130
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8805
Practice Address - Country:US
Practice Address - Phone:909-576-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT JAMES HOUCHIN DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty