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Organization
WILDWOOD DENTAL GROUP
Active
Organization
WILDWOOD DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE M JUSTIN DDS INC (PRESIDENT)
(909) 886-4864
Entity
Organization
Contact information
Practice address
3972 N WATERMAN AVE, SAN BERNARDINO, CA 92404-1700
(909) 886-4864
Mailing address
2413 S GROVE AVE, ONTARIO, CA 91761-6225
(909) 886-4864
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
51084
CA
Other
Enumeration date
03/20/2014
Last updated
05/27/2014
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