Provider Demographics
NPI:1013435403
Name:DENTAL FACULTY ASSOCIATES
Entity Type:Organization
Organization Name:DENTAL FACULTY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-558-6468
Mailing Address - Street 1:25455 BARTON RD STE 203B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3130
Mailing Address - Country:US
Mailing Address - Phone:909-558-6468
Mailing Address - Fax:909-558-6469
Practice Address - Street 1:25455 BARTON ROAD
Practice Address - Street 2:SUITE 203B
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-6468
Practice Address - Fax:909-558-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0360771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty