Organization
LOMA LINDA CHILDREN'S DENTAL GROUP
Active
Other names
Chris Wacker, LLCDG Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER E WACKER DDS (OWNER)
(909) 796-2507
Entity
Organization
Contact information
Practice address
25455 BARTON RD, SUITE 205B, LOMA LINDA, CA 92354-3128
(909) 796-2507
(909) 796-3247
Mailing address
25455 BARTON RD, SUITE 205B, LOMA LINDA, CA 92354-3128
(909) 796-2507
(909) 796-3247
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
36101
CA
1223P0221X
Pediatric Dentistry
Primary
43267
CA
1223P0221X
Pediatric Dentistry
43508
CA
Other
Enumeration date
01/22/2007
Last updated
04/16/2013
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