Individual
MAURICIO GONZALEZ BALUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
159 W HOSPITALITY LN STE 100, SAN BERNARDINO, CA 92408-3348
(909) 558-4960
Mailing address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4603
(909) 558-4822
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
SP313
CA
Other
Enumeration date
02/01/2024
Last updated
02/01/2024
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