Provider Demographics
NPI:1679973036
Name:WENDY SUGIONO, DDS, MAGD, INC.
Entity Type:Organization
Organization Name:WENDY SUGIONO, DDS, MAGD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGIONO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-980-1411
Mailing Address - Street 1:9482 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5822
Mailing Address - Country:US
Mailing Address - Phone:909-980-1411
Mailing Address - Fax:909-980-7061
Practice Address - Street 1:9482 BASELINE RD
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5822
Practice Address - Country:US
Practice Address - Phone:909-980-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279311223G0001X
CA625521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty