Organization
BROCKTON DENTAL X-RAY LAB., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL W. CARPENTER (OWNER)
(951) 682-7505
Entity
Organization
Contact information
Practice address
6800 BROCKTON AVE STE 3, RIVERSIDE, CA 92506-3810
(951) 682-7505
(951) 682-7549
Mailing address
6800 BROCKTON AVE STE 3, RIVERSIDE, CA 92506-3810
(951) 682-7505
(951) 682-7549
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
RHP00050468
CA
292200000X
Dental Laboratory
RHP7971
CA
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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