Provider Demographics
NPI:1609358845
Name:ARTEAGA DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARTEAGA DENTAL CORPORATION
Other - Org Name:ARTEAGA DENTAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-875-8930
Mailing Address - Street 1:228 W BASE LINE RD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3306
Mailing Address - Country:US
Mailing Address - Phone:909-875-8930
Mailing Address - Fax:
Practice Address - Street 1:494 S RANCHO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2144
Practice Address - Country:US
Practice Address - Phone:909-875-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740468339OtherDENTICAL