Organization
KETCHERSIDE DENTAL CORPORATION
Active
Other names
Brace Connection, Gary Ketcherside Orthodontics INC, Packing House District Dental & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
HOMER KETCHERSIDE DDS (PRESIDENT)
(909) 810-7167
Entity
Organization
Contact information
Practice address
720 MAGNOLIA AVE STE A1, CORONA, CA 92879-3119
(951) 737-3800
(951) 737-3937
Mailing address
400 W STUART AVE STE 110, REDLANDS, CA 92374-3129
(909) 793-1595
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
28872
CA
Other
Enumeration date
08/10/2018
Last updated
05/11/2020
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