Provider Demographics
NPI:1922292234
Name:HEALTHY HABIT DENTAL TEMECULA
Entity Type:Organization
Organization Name:HEALTHY HABIT DENTAL TEMECULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-695-3274
Mailing Address - Street 1:27625 JEFFERSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2619
Mailing Address - Country:US
Mailing Address - Phone:951-695-3274
Mailing Address - Fax:951-695-3275
Practice Address - Street 1:27625 JEFFERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2619
Practice Address - Country:US
Practice Address - Phone:951-695-3274
Practice Address - Fax:951-695-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty