Provider Demographics
NPI:1699508150
Name:SUGIONO, CHASE
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:
Last Name:SUGIONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30372 E SUNSET DR S
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7323
Mailing Address - Country:US
Mailing Address - Phone:909-657-7616
Mailing Address - Fax:
Practice Address - Street 1:7251 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3811
Practice Address - Country:US
Practice Address - Phone:951-689-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice