Provider Demographics
NPI:1669618062
Name:SON, CHRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S MEADOW LN
Mailing Address - Street 2:UNIT 134
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6481
Mailing Address - Country:US
Mailing Address - Phone:714-392-5132
Mailing Address - Fax:
Practice Address - Street 1:12223 HIGHLAND AVE
Practice Address - Street 2:STE 104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2574
Practice Address - Country:US
Practice Address - Phone:909-463-7890
Practice Address - Fax:303-463-7367
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice