Provider Demographics
NPI:1962578930
Name:VIRGIN, FENNY (DDS)
Entity type:Individual
Prefix:
First Name:FENNY
Middle Name:
Last Name:VIRGIN
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 1:6877 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3905
Mailing Address - Country:US
Mailing Address - Phone:951-898-6806
Mailing Address - Fax:
Practice Address - Street 1:4036 GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5487
Practice Address - Country:US
Practice Address - Phone:909-627-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist