Provider Demographics
NPI:1578758967
Name:MUENI L. MUTINGA D.D.S. DENTAL CORPORATION
Entity Type:Organization
Organization Name:MUENI L. MUTINGA D.D.S. DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUENI
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:MUTINGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-810-9930
Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3250
Mailing Address - Country:US
Mailing Address - Phone:951-786-9600
Mailing Address - Fax:
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3250
Practice Address - Country:US
Practice Address - Phone:951-786-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty