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Organization
K.SUMARDI DDS INC.
Active
Organization
K.SUMARDI DDS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KUSUMO SUMARDI (PRESIDENT)
(909) 596-6500
Entity
Organization
Contact information
Practice address
1965 FOOTHILL BLVD STE L, LA VERNE, CA 91750-3502
(909) 596-6500
(909) 596-8809
Mailing address
1965 FOOTHILL BLVD STE L, LA VERNE, CA 91750-3502
(909) 596-6500
(909) 596-8809
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
41680
CA
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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