Individual
HOMER GARY KETCHERSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
720 MAGNOLIA AVE, SUITE A1, CORONA, CA 92879-3119
(951) 737-3800
(951) 737-3937
Mailing address
720 MAGNOLIA AVE, SUITE A1, CORONA, CA 92879-3119
(951) 737-3802
(951) 737-3937
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
28872
CA
Other
Enumeration date
05/17/2012
Last updated
07/22/2013
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