Provider Demographics
NPI:1780089938
Name:TODD EHRLER PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:TODD EHRLER PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:EHRLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-851-2541
Mailing Address - Street 1:14976 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-7045
Mailing Address - Country:US
Mailing Address - Phone:909-350-8730
Mailing Address - Fax:909-350-8733
Practice Address - Street 1:14976 FOOTHILL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-7045
Practice Address - Country:US
Practice Address - Phone:909-350-8730
Practice Address - Fax:909-350-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184706483OtherTODD BRIAN EHRLER, OFFICER, INDIVIDUAL NPI