Individual
MR. DERRICK TRIGENZA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S.D.H.
Contact information
Practice address
23569 SUNNYMEAD RANCH PARKWAY, MORENO VALLEY, CA 92557
(951) 242-8282
Mailing address
11383 BOONE WAY, LOMA LINDA, CA 92354
(909) 796-9676
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
19816
CA
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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