1770863151 NPI number — KUMAR AND STROMBERG DENTAL CORPORATION

Table of content: MS. ERICA NICOLE THREET B.A. (NPI 1427145101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770863151 NPI number — KUMAR AND STROMBERG DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUMAR AND STROMBERG DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770863151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2860 MICHELLE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-947-5435
Provider Business Mailing Address Fax Number:
760-949-2459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12821 MAIN ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HESPERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92345-9127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-947-5435
Provider Business Practice Location Address Fax Number:
760-949-2459
Provider Enumeration Date:
08/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STROMBERG
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
760-947-5435

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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