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Contact Information

MAVERN SUPRONO, DDS
1080 E WASHINGTON
B
COLTON, CA92324
 Phone: 909-783-9099
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for MAVERN SUPRONO · (Male)

NPI Number 1023239944
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 05/01/2007
Last updated 07/08/2007 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • CA License # 27842
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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