Organization
BOLSA DENTAL CENTER
Active
Other names
Riverwalk Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRUC TRUNG MAI D.D.S. (DENTIST)
(951) 353-0050
Entity
Organization
Contact information
Practice address
11695 SLATE AVE STE 200, RIVERSIDE, CA 92505-5197
(951) 353-0050
(951) 353-0060
Mailing address
11695 SLATE AVE STE 200, RIVERSIDE, CA 92505-5197
(951) 353-0050
(951) 353-0060
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
44933
CA
1223G0001X
General Practice Dentistry
Primary
44934
CA
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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