Organization · NPI-2

Jorge L. Geronimo, DDS Prof. Dental Corp.

Preferred Provider Organization · Riverside, CA

NPI number1265809065
StatusActive
Last updated in NPPESJan 3, 2020

Details

NPI
1265809065
Entity type
Organization (NPI-2)
Legal business name
Jorge L. Geronimo, DDS Prof. Dental Corp.
Organization subpart
Yes
Enumeration date
Aug 27, 2015
Certification date
Jan 3, 2020
Last updated
Jan 3, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
305R00000X Preferred Provider Organization47897CAYes

Practice location

9720 Magnolia Ave Suite #100
Riverside, CA 92503

Phone 951-696-3663 · Fax 951-696-3887

Mailing address

9720 Magnolia Ave Suite 100
Riverside, CA 92503

Phone 951-696-3663 · Fax 951-696-3887

Authorized official

Jorge Luis Geronimo
Dentist
7142676400

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Preferred Provider Organization providers in Riverside, CA