Individual
MRS. MITRA BOLBOLAN MACMILLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
4264 GREEN RIVER RD, CORONA, CA 92880-1669
(951) 340-0200
(951) 278-9858
Mailing address
4264 GREEN RIVER RD, CORONA, CA 92880-1669
(951) 340-0200
(951) 278-9858
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
42808
CA
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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