Provider Demographics
NPI:1245260421
Name:CALIFORNIA DENTAL SURGERY CENTERS, INC
Entity type:Organization
Organization Name:CALIFORNIA DENTAL SURGERY CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:N ED
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:I
Authorized Official - Credentials:FACHE, MBA
Authorized Official - Phone:909-261-8503
Mailing Address - Street 1:906 SOUTH GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4808
Mailing Address - Country:US
Mailing Address - Phone:626-852-9500
Mailing Address - Fax:909-949-6919
Practice Address - Street 1:906 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4808
Practice Address - Country:US
Practice Address - Phone:626-852-9500
Practice Address - Fax:909-949-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPLLYING FOR NOW1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty