Organization
CROWN CONCORDIA DENTAL NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAGNER DE LUCA FARIA DDS (PRESIDENT)
(909) 885-7600
Entity
Organization
Contact information
Practice address
290 W ORANGE SHOW RD, SUITE 105, SAN BERNARDINO, CA 92408-3345
(909) 885-7600
(909) 885-7612
Mailing address
290 W ORANGE SHOW RD, SUITE 105, SAN BERNARDINO, CA 92408-3345
(909) 885-7600
(909) 885-7612
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
44169
CA
Other
Enumeration date
10/25/2007
Last updated
10/25/2007
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