Provider Demographics
NPI:1780708768
Name:ASSISTANCE LEAGUE OF SAN BERNARDINO
Entity type:Organization
Organization Name:ASSISTANCE LEAGUE OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR, DR. EARL R. CRANE CHILDREN'S
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-885-2045
Mailing Address - Street 1:580 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3002
Mailing Address - Country:US
Mailing Address - Phone:909-885-2045
Mailing Address - Fax:909-885-5900
Practice Address - Street 1:580 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3002
Practice Address - Country:US
Practice Address - Phone:909-885-2045
Practice Address - Fax:909-885-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty