Provider Demographics
NPI:1427120815
Name:CZARINNE A FETALINO DMD INC
Entity type:Organization
Organization Name:CZARINNE A FETALINO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CZARINNE
Authorized Official - Middle Name:ANO
Authorized Official - Last Name:FETALINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-396-7207
Mailing Address - Street 1:1220 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-396-7207
Mailing Address - Fax:909-396-7242
Practice Address - Street 1:1220 S DIAMOND BAR BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-396-7207
Practice Address - Fax:909-396-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty