Individual
MARIA ANTONETTE DE LARA KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, RDHAP
Contact information
Practice address
66 S SAN GORGONIO AVE STE 5, BANNING, CA 92220-6020
(951) 553-8235
Mailing address
66 S SAN GORGONIO AVE STE 5, BANNING, CA 92220-6020
(951) 922-4975
(951) 922-4976
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
783
CA
Other
Enumeration date
11/07/2020
Last updated
03/04/2021
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