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Organization
TED T. IM, DDS, INC.
Active
Organization
TED T. IM, DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TED IM DDS (PRESIDENT)
(951) 242-6242
Entity
Organization
Contact information
Practice address
23205 SUNNYMEAD BLVD, MORENO VALLEY, CA 92553-5246
(951) 242-6242
(951) 242-4782
Mailing address
23205 SUNNYMEAD BLVD, MORENO VALLEY, CA 92553-5246
(951) 242-6242
(951) 242-4782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40950
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D40950
—
CA
Enumeration date
01/30/2013
Last updated
09/15/2016
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