Organization
UNITED DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RAFAELA DELARA (ADMINISTRATOR)
(909) 793-8793
Entity
Organization
Contact information
Practice address
434 CAJON ST, SUITE 101, REDLANDS, CA 92373-5978
(909) 793-8793
Mailing address
434 CAJON ST, SUITE 101, REDLANDS, CA 92373-5978
(909) 793-8793
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
46985
CA
1223G0001X
General Practice Dentistry
53832
CA
1223G0001X
General Practice Dentistry
57581
CA
1223G0001X
General Practice Dentistry
57930
CA
1223G0001X
General Practice Dentistry
58057
CA
1223G0001X
General Practice Dentistry
59318
CA
1223P0300X
Periodontics
38226
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
24358
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
48644
CA
124Q00000X
Dental Hygienist
25296
CA
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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