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Organization
PEDRO M SANDOVAL DDS CORPORATION
Active
Organization
PEDRO M SANDOVAL DDS CORPORATION
Active
Other names
Blue Crystal Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PEDRO M SANDOVAL D.D.S., M.B.A (PRESIDENT)
(909) 873-9707
Entity
Organization
Contact information
Practice address
432 N RIVERSIDE AVE, RIALTO, CA 92376-5012
(909) 874-2121
Mailing address
432 N RIVERSIDE AVE, RIALTO, CA 92376-5012
(909) 874-2121
(900) 874-2122
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
49402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194941245
EIN
CA
01
—
G8924701
MEDI-CAL
CA
Enumeration date
08/22/2011
Last updated
04/09/2019
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