Provider Demographics
NPI:1023818358
Name:EUCLID AVENUE DENTAL INC
Entity type:Organization
Organization Name:EUCLID AVENUE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANO BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-556-4386
Mailing Address - Street 1:600 N EUCLID AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4779
Mailing Address - Country:US
Mailing Address - Phone:909-981-8781
Mailing Address - Fax:909-981-8783
Practice Address - Street 1:600 N EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4779
Practice Address - Country:US
Practice Address - Phone:909-981-8781
Practice Address - Fax:909-981-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental