Provider Demographics
NPI:1932379948
Name:GROVE MARKETPLACE DENTAL
Entity Type:Organization
Organization Name:GROVE MARKETPLACE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-923-0999
Mailing Address - Street 1:1150 E PHILADELPHIA ST
Mailing Address - Street 2:110
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-5690
Mailing Address - Country:US
Mailing Address - Phone:909-923-0999
Mailing Address - Fax:909-923-0992
Practice Address - Street 1:1150 E PHILADELPHIA ST
Practice Address - Street 2:110
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-5690
Practice Address - Country:US
Practice Address - Phone:909-923-0999
Practice Address - Fax:909-923-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty