Organization
MC CORMACK DENTAL XRAY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VALERIE J WELLS LICENSED CALIFORNIA (PRESIDENT/X-RAY TECH)
(909) 921-4273
Entity
Organization
Contact information
Practice address
395 N. SECOND AVE., UPLAND, CA 91786
(909) 985-3030
(909) 946-1200
Mailing address
395 N. SECOND AVE., UPLAND, CA 91786
(909) 985-3030
(909) 946-1200
Taxonomy
Speciality
Code
Description
License number
State
2471C3401X
Computed Tomography Radiologic Technologist
Primary
RHP00040925
CA
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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