Provider Demographics
NPI:1720154370
Name:PIEDRA, ISABELLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:
Last Name:PIEDRA
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 1:9469 HAVEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5305
Mailing Address - Country:US
Mailing Address - Phone:909-499-9093
Mailing Address - Fax:909-793-7781
Practice Address - Street 1:9469 HAVEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5305
Practice Address - Country:US
Practice Address - Phone:909-483-6851
Practice Address - Fax:909-483-6853
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry