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Organization
MARVIN E. OTA, DDS
Active
Organization
MARVIN E. OTA, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN EIJI OTA D.D.S. (OWNER)
(909) 797-8090
Entity
Organization
Contact information
Practice address
11834 BRYANT ST, SUITE 103, YUCAIPA, CA 92399-3815
(909) 797-8090
Mailing address
11834 BRYANT ST, SUITE 103, YUCAIPA, CA 92399-3815
(909) 797-8090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
28214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B28214-01
—
CA
Enumeration date
05/31/2009
Last updated
05/31/2009
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