Harley Albert Deisem JR. DDS

NPI 1093820557 - Dentist - 1223G0001X

NPI Details
NPI 1093820557
Gender Male
Enumeration Date 08/21/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
12875 MOUNTAIN AVE
CHINO CA, 91710-4556, US
Phone (909) 591-0316
Fax (909) 628-4823
Business Location
12875 MOUNTAIN AVE
CHINO CA, 91710-4556, US
Phone (909) 591-0316
Fax (909) 628-4823
Toxanomy
Taxonomy Code 1223G0001X
License State California
License Number 029698
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According to our database, Dr. Harley Albert Deisem JR. DDS NPI is 1093820557, taxonomy code is 1223G0001X and license number is 029698, license state is located at California. Harley Albert Deisem JR. DDS physically located at 12875 Mountain Ave, Chino CA, 91710-4556. NPI Number Harley Albert Deisem JR. DDS has the Individual type.

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1093820557 NPI number is provided on an as is basis without warranty of any kind. 1093820557 is maintained by the National Plan & Provider Enumeration System. The contents of Harley Albert Deisem JR. DDS are for informational purposes only.