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Organization
IRENE M JUSTIN WILDWOOD DENTAL GROUP
Active
Organization
IRENE M JUSTIN WILDWOOD DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRENE JUSTIN DDS (PRESIDENT)
(951) 536-8419
Entity
Organization
Contact information
Practice address
3972 N WATERMAN AVE STE 110, SAN BERNARDINO, CA 92404-1767
(909) 947-9700
Mailing address
2413 S GROVE AVE, ONTARIO, CA 91761-6225
(909) 947-9700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
51084
CA
Other
Enumeration date
10/23/2009
Last updated
10/23/2009
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