Individual
DR. BOTAMENA M MYLAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12571 LIMONITE AVE STE 230, EASTVALE, CA 91752-3677
(951) 360-3444
Mailing address
12571 LIMONITE AVE STE 230, EASTVALE, CA 91752-3677
(951) 360-3444
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
103690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103690
LICENSE NUMBER
CA
Enumeration date
06/14/2019
Last updated
06/14/2019
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