Organization
COPPER CANYON SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL QUINTERO (BILLER)
(951) 691-5096
Entity
Organization
Contact information
Practice address
23771 WASHINGTON AVE, SUITE H102, MURRIETA, CA 92562-2278
(951) 691-5096
(951) 691-5097
Mailing address
23771 WASHINGTON AVE, SUITE H102, MURRIETA, CA 92562-2278
(951) 691-5096
(951) 691-5097
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
53453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881095115
—
CA
Enumeration date
05/09/2017
Last updated
05/09/2017
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