Ethar Riyadh Al-Wazeer, DDS
Individual provider Active NPI Dentist · Fontana, CA
NPI 1366054348 · NPPES record last updated Sep 11, 2020
Key facts
- NPI
- 1366054348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 105309 (CA)
- Practice address
- 10144 Sierra Ave
Fontana, CA 92335-6725 - Phone
- (909) 770-7367
- NPI assigned
- Aug 20, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 105309 | CA | Yes |
Addresses
Primary practice location
10144 Sierra Ave
Fontana, CA 92335-6725
Mailing address
1510 Orange Ave Apt 304
Redlands, CA 92373-1493
Phone (630) 408-9723
Other practice location 1
1510 Orange Ave Apt 304
Redlands, CA 92373-1493
Phone (630) 408-9723
Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.