Provider Demographics
NPI:1598489882
Name:CHILDREN DENTAL WORLD RIVERSIDE
Entity Type:Organization
Organization Name:CHILDREN DENTAL WORLD RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-988-0574
Mailing Address - Street 1:3457 ARLINGTON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3220
Mailing Address - Country:US
Mailing Address - Phone:909-881-0003
Mailing Address - Fax:
Practice Address - Street 1:3457 ARLINGTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3220
Practice Address - Country:US
Practice Address - Phone:909-881-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty