Provider Demographics
NPI:1285889576
Name:CAMBERO-MUSTAFA DENTAL CORPORATION
Entity type:Organization
Organization Name:CAMBERO-MUSTAFA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:CAMBERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-350-2583
Mailing Address - Street 1:8312 JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-0329
Mailing Address - Country:US
Mailing Address - Phone:909-350-2583
Mailing Address - Fax:909-350-7820
Practice Address - Street 1:8312 JUNIPER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0329
Practice Address - Country:US
Practice Address - Phone:909-350-2583
Practice Address - Fax:909-350-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494801223G0001X
CA423741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty