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Organization
FONTANA MODERN DENTISTRY, INC
Active
Organization
FONTANA MODERN DENTISTRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON SUN (OWNER)
(714) 845-8500
Entity
Organization
Contact information
Practice address
10189 CITRUS AVE, SUITE 500, FONTANA, CA 92335
(909) 657-2736
Mailing address
PO BOX 660041, DALLAS, TX 75266-0041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/09/2025
Last updated
07/30/2025
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