Organization
LOMA LINDA UNIVERSITY SCHOOL OF DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODNEY DALE NEAL (SR. VICE PRESIDENT)
(909) 558-4543
Entity
Organization
Contact information
Practice address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4613
(909) 558-4192
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2056
STATE LICENSE NUMBER
—
Enumeration date
10/03/2007
Last updated
03/18/2020
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