Homer Gary Ketcherside
Orthodontists
720 Magnolia Ave Suite A1
Corona
, California 92879-3119
Homer Gary Ketcherside
Orthodontists
720 Magnolia Ave Suite A1
Corona
, California 92879-3119
(951) 737-3937
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About
Features
Specialties
- Orthodontists
Languages spoken
- English
Location
First Address
- Homer Gary Ketcherside
- 720 Magnolia Ave Suite A1
- Corona, CA
- Zip : 92879-3119
- Fax : (951) 737-3937
- Phone : (951) 737-3802
Second Address
- Homer Gary Ketcherside
- 720 Magnolia Ave Suite A1
- Corona, CA
- Zip : 92879-3119
- Fax : (951) 737-3937
- Phone : (951) 737-3800
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Is Homer Gary Ketcherside accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223X0400X | Orthodontists | 28872 | CA |
National Provider Identifier
| NPI | 1043570658 |
|---|---|
| Provider Name | Homer Gary Ketcherside |
| First Address | Corona, CA 92879-3119 |
| Second Address | Corona, CA 92879-3119 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/05/2012 |
| Last Update Date | 22/07/2013 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.