SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC NPI 1588715031

NPI Information

SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC is a general practice dentist in San Bernardino, CA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC NPI is 1588715031. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Southland Dental Group Antoine Sourialle Dds.

The provider's business location address is:

399 E HIGHLAND AVE
SUITE 120
SAN BERNARDINO, CA
ZIP 92404-808
Phone: (909) 881-0645
Fax: (909) 881-4957

The provider's authorized official is Antoine O Sourialle .
The authorized official title is Owner and has the following contact phone number (909) 881-0645.

The enumeration date for this NPI number is 1/12/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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