Provider Demographics
NPI:1609536416
Name:APPLE VALLEY PERIODONTAL ASSOCIATES
Entity Type:Organization
Organization Name:APPLE VALLEY PERIODONTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYN
Authorized Official - Middle Name:KENDRA
Authorized Official - Last Name:AFFRUNTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-946-2100
Mailing Address - Street 1:10630 TOWN CENTER DR STE 125
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6889
Mailing Address - Country:US
Mailing Address - Phone:909-483-3131
Mailing Address - Fax:
Practice Address - Street 1:18092 WIKA RD STE 210
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2132
Practice Address - Country:US
Practice Address - Phone:760-946-2100
Practice Address - Fax:
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
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty