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Organization
MYLAD DENTAL CORPORATION
Active
Organization
MYLAD DENTAL CORPORATION
Active
Other names
Moreno Valley Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BOTAMENA MYLAD DDS (OWNER)
(951) 220-6980
Entity
Organization
Contact information
Practice address
24119 HEMLOCK AVE STE 108, MORENO VALLEY, CA 92557-7221
(951) 220-6980
(951) 465-2634
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8890
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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