Provider Demographics
NPI:1881829521
Name:FORD, DRUECIEL ORLEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DRUECIEL
Middle Name:ORLEAN
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1560 N ARROYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2026
Mailing Address - Country:US
Mailing Address - Phone:626-375-3299
Mailing Address - Fax:626-628-0467
Practice Address - Street 1:4129 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3183
Practice Address - Country:US
Practice Address - Phone:909-591-9211
Practice Address - Fax:909-613-0601
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB26757-01OtherMEDICAL