Provider Demographics
NPI:1962972158
Name:ARROWHEAD VILLAGE DENTAL GROUP
Entity type:Organization
Organization Name:ARROWHEAD VILLAGE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASH
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:DASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-904-3956
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-0241
Mailing Address - Country:US
Mailing Address - Phone:909-904-3956
Mailing Address - Fax:
Practice Address - Street 1:28200 HIGHWAY 189 # 0250
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-9700
Practice Address - Country:US
Practice Address - Phone:909-337-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental