Hanawalt Dental Corporation
Dentist, General Practice in La Verne, CA. Organization (NPI-2).
NPI number1962890632
StatusActive
Last updated in NPPESJan 5, 2015
Details
- NPI
- 1962890632
- Entity type
- Organization (NPI-2)
- Legal business name
- Hanawalt Dental Corporation
- Organization subpart
- No
- Enumeration date
- Jan 5, 2015
- Last updated
- Jan 5, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
| 124Q00000X | Dental Hygienist | – | – |
Practice location
2450 D StLa Verne, CA 91750-4416
Phone 909-593-4581
Mailing address
2450 D StLa Verne, CA 91750-4416
Phone 909-593-4581
Authorized official
Roger M Hanawalt
Owner
9095934581
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