Individual
CARLOS ALBERTO PONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4663
(909) 558-0463
Mailing address
186 CHESHIRE LN, SAN BERNARDINO, CA 92408-4151
(909) 754-8004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
101645
CA
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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