Provider Demographics
NPI:1578223582
Name:G & M DENTAL CORPORATION
Entity Type:Organization
Organization Name:G & M DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-941-9328
Mailing Address - Street 1:1227 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3681
Mailing Address - Country:US
Mailing Address - Phone:909-608-0700
Mailing Address - Fax:909-608-0704
Practice Address - Street 1:1227 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3681
Practice Address - Country:US
Practice Address - Phone:909-608-0700
Practice Address - Fax:909-608-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty