Provider Demographics
NPI:1194919290
Name:DIAMOND BAR DENTAL GROUP
Entity type:Organization
Organization Name:DIAMOND BAR DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-396-0077
Mailing Address - Street 1:2040 S BREA CANYON RD
Mailing Address - Street 2:STE 210
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4008
Mailing Address - Country:US
Mailing Address - Phone:909-396-0077
Mailing Address - Fax:
Practice Address - Street 1:2040 S. BREA CANYON RD
Practice Address - Street 2:STE 210
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4008
Practice Address - Country:US
Practice Address - Phone:909-396-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty