Organization
SOCAL DENTAL SPECIALISTS DENTAL GROUP OF DR. UMMETHALA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KITICHAI RUNGCHARASSAENG DDS (ORTHODONTIST)
(909) 500-2705
Entity
Organization
Contact information
Practice address
1460 FORD ST., STE 105, REDLANDS, CA 92373
(909) 500-2705
(909) 500-3930
Mailing address
1461 FORD ST., STE 105, REDLANDS, CA 92373
(909) 500-2705
(909) 500-3930
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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