Organization
LOMA LINDA UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODNEY DALE NEAL (SR. VICE PRESIDENT)
(909) 558-4543
Entity
Organization
Contact information
Practice address
11092 ANDERSON STREET, LOMA LINDA, CA 92354
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON STREET, LOMA LINDA, CA 92354
(909) 558-4613
(909) 558-4192
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
G91288-01
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G91288-01
STATE LICENSE NUMBER
CA
Enumeration date
06/21/2007
Last updated
03/18/2020
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