Provider Demographics
NPI:1851091789
Name:REDFORD FALLBROOK DENTAL CORPORATION
Entity Type:Organization
Organization Name:REDFORD FALLBROOK DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-677-5113
Mailing Address - Street 1:521 E ELDER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3083
Mailing Address - Country:US
Mailing Address - Phone:760-280-6727
Mailing Address - Fax:
Practice Address - Street 1:521 E ELDER ST STE 203
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3083
Practice Address - Country:US
Practice Address - Phone:760-280-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental