Provider Demographics
NPI:1841485646
Name:MORENO VALLEY DENTAL CENTER
Entity type:Organization
Organization Name:MORENO VALLEY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-242-2600
Mailing Address - Street 1:24266 POSTAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3081
Mailing Address - Country:US
Mailing Address - Phone:951-242-2600
Mailing Address - Fax:
Practice Address - Street 1:24266 POSTAL AVE
Practice Address - Street 2:STE 100
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3081
Practice Address - Country:US
Practice Address - Phone:951-242-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2021-07-15
Deactivation Date:2008-08-08
Deactivation Code:
Reactivation Date:2011-05-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty