Organization
CADALSO DENTAL CORPORATION
Active
Other names
American Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT T CADALSO JR. D.D.S. (PRESIDENT)
(909) 626-1100
Entity
Organization
Contact information
Practice address
4380 HOLT BLVD STE E, MONTCLAIR, CA 91763-5407
(909) 626-1100
(909) 626-1120
Mailing address
4380 HOLT BLVD STE E, MONTCLAIR, CA 91763-5407
(909) 626-1100
(909) 626-1120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30639
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003934761
IND NPI
—
01
—
30639
STATE LICENSE
CA
Enumeration date
05/05/2011
Last updated
05/05/2011
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