Provider Demographics
NPI:1760583124
Name:TONY DAHER DDS INC
Entity Type:Organization
Organization Name:TONY DAHER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-596-6779
Mailing Address - Street 1:1413 FOOTHILL BLVD
Mailing Address - Street 2:#A
Mailing Address - City:LAVERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:909-596-6779
Mailing Address - Fax:909-593-0969
Practice Address - Street 1:1413 FOOTHILL BLVD
Practice Address - Street 2:#A
Practice Address - City:LAVERNE
Practice Address - State:CA
Practice Address - Zip Code:91750
Practice Address - Country:US
Practice Address - Phone:909-596-6779
Practice Address - Fax:909-593-0969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30334122300000X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No122300000XDental ProvidersDentistGroup - Single Specialty