Provider Demographics
NPI:1205258886
Name:CHILDREN DENTAL CARE CENTER
Entity type:Organization
Organization Name:CHILDREN DENTAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHEN-DER
Authorized Official - Last Name:CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-369-1177
Mailing Address - Street 1:2079 COMPTON AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7284
Mailing Address - Country:US
Mailing Address - Phone:951-403-6288
Mailing Address - Fax:626-369-1186
Practice Address - Street 1:2079 COMPTON AVE STE 101B
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7284
Practice Address - Country:US
Practice Address - Phone:951-403-6288
Practice Address - Fax:626-369-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty