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Organization
TENNESSEE DENTAL CORPORATION
Active
Organization
TENNESSEE DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EPIFANIA V NICOLAS (CEO)
(714) 906-9116
Entity
Organization
Contact information
Practice address
414 TENNESSEE ST, REDLANDS, CA 92373-8163
(909) 798-4000
Mailing address
414 TENNESSEE ST STE K1, REDLANDS, CA 92373-8152
(909) 798-4000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
40290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B4029004
—
CA
Enumeration date
04/20/2016
Last updated
11/13/2016
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