Provider Demographics
NPI:1922237155
Name:COMMUNITY DENTAL OF DR. CHI
Entity Type:Organization
Organization Name:COMMUNITY DENTAL OF DR. CHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHING-ROO
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,BDS
Authorized Official - Phone:951-488-8688
Mailing Address - Street 1:11875 PIGEON PASS RD
Mailing Address - Street 2:SUITE B9
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6039
Mailing Address - Country:US
Mailing Address - Phone:951-488-8688
Mailing Address - Fax:951-488-8689
Practice Address - Street 1:11875 PIGEON PASS RD
Practice Address - Street 2:BUITE B9
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6039
Practice Address - Country:US
Practice Address - Phone:951-488-8688
Practice Address - Fax:951-488-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty