Individual
DR. ANTOINE O. SOURIALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
399 E HIGHLAND AVE STE 120, SAN BERNARDINO, CA 92404-3812
(909) 881-0645
(909) 881-4957
Mailing address
399 E HIGHLAND AVE STE 120, SAN BERNARDINO, CA 92404-3812
(909) 881-0645
(909) 881-4957
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
44093
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004636
MANAGED DENTAL CARE
CA
01
—
0010973
ASSURANT HMO
CA
01
—
004239
LIBERTY DENTAL HMO
CA
01
—
007367
PMI
CA
01
—
01628
WESTERN DENTAL
CA
01
—
0210745
CIGNA HMO
CA
01
—
10490
PACIFICARE
CA
01
—
134921
DHS HMO
CA
01
—
20088156
PRIVIOUS EIN
CA
01
—
50755-1
BLUE SHIELD
CA
01
—
97036530
SAFEGUARD HMO
CA
01
—
D44093
DENT-CAL
CA
01
—
DJ61
SMILESAVER
CA
01
—
F0275
GOLDENWEST
CA
01
—
P006271
WELLPOINT DENTAL
CA
Enumeration date
03/30/2007
Last updated
07/08/2007
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