DR. Harley Albert Deisem JR., DDS

NPI #1093820557 in Chino, California

Provider Information

NPI Number: 1093820557
Entity Type: Individual
Name: DR. Harley Albert Deisem JR., DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: DDS
Enumeration Date: Aug 21, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 12875 MOUNTAIN AVE
City: Chino
State: California
ZIP Code: 91710-4556
Phone: (909) 591-0316

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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