Provider Demographics
NPI:1508094061
Name:INLAND DENTISTRY, INC
Entity Type:Organization
Organization Name:INLAND DENTISTRY, INC
Other - Org Name:MANUEL ARTEAGA/ANGEL BOLOICO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-352-7260
Mailing Address - Street 1:10411 MAGNOLIA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1894
Mailing Address - Country:US
Mailing Address - Phone:951-352-7260
Mailing Address - Fax:951-352-6237
Practice Address - Street 1:10411 MAGNOLIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1894
Practice Address - Country:US
Practice Address - Phone:951-352-7260
Practice Address - Fax:951-352-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA719157OtherUNITED CONCORDIA