Provider Demographics
NPI:1023707627
Name:KIDS DENTAL R US COLTON
Entity type:Organization
Organization Name:KIDS DENTAL R US COLTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:R MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-988-0574
Mailing Address - Street 1:1145 N. MOUNT VERNON AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-453-0244
Mailing Address - Fax:
Practice Address - Street 1:1145 N. MOUNT VERNON AVE UNIT B
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-453-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty