Provider Demographics
NPI:1023269420
Name:MARJORIE A RAMOS DMD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARJORIE A RAMOS DMD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:ARCANGEL
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-425-2700
Mailing Address - Street 1:4160 HIGHLAND AVE STE 6-C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2757
Mailing Address - Country:US
Mailing Address - Phone:909-425-2700
Mailing Address - Fax:909-425-2727
Practice Address - Street 1:4160 HIGHLAND AVE STE 6-C
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2757
Practice Address - Country:US
Practice Address - Phone:909-425-2700
Practice Address - Fax:909-425-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42520-01OtherDENTICAL