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Organization
MIMI THEERATHADA DENTAL CORPORATION
Active
Organization
MIMI THEERATHADA DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIMI THEERATHADA DMD (DOCTOR)
(714) 839-3112
Entity
Organization
Contact information
Practice address
9972 BOLSA AVE, 102, WESTMINSTER, CA 92683-6069
(714) 839-3112
Mailing address
9972 BOLSA AVE, 102, WESTMINSTER, CA 92683-6069
(714) 839-3112
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
56371
CA
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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