Provider Demographics
NPI:1649851643
Name:RICARDO FRANK JARA CASTRO DDS, INC.
Entity type:Organization
Organization Name:RICARDO FRANK JARA CASTRO DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:JARA CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-539-3506
Mailing Address - Street 1:1355 S GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4412
Mailing Address - Country:US
Mailing Address - Phone:909-620-4600
Mailing Address - Fax:
Practice Address - Street 1:1355 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4412
Practice Address - Country:US
Practice Address - Phone:909-620-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental