Provider Demographics
NPI:1598973810
Name:FERNANDO MUNGUIA DDS, INC
Entity type:Organization
Organization Name:FERNANDO MUNGUIA DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-373-4600
Mailing Address - Street 1:1060 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3730
Mailing Address - Country:US
Mailing Address - Phone:909-373-4600
Mailing Address - Fax:909-373-4900
Practice Address - Street 1:1060 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3730
Practice Address - Country:US
Practice Address - Phone:909-373-4600
Practice Address - Fax:909-373-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425781223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty