PACKING HOUSE DISTRICT DENTAL & ORTHODONTICS
NPI 1629557517
Dentist - Orthodontics and Dentofacial Orthopedics in Corona, CA

Active since August 10, 2018
720 MAGNOLIA AVE STE A1, CORONA, CA 92879(951) 737-3800(951) 737-3937 Get Directions Write a Review

NPPES record last updated: May 11, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 11, 2020, Aug 10, 2018 (2 updates tracked since 2018).

About Packing House District Dental & Orthodontics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PACKING HOUSE DISTRICT DENTAL & ORTHODONTICS (NPI 1629557517) is a healthcare organization registered as an orthodontics and dentofacial orthopedics in Corona, California and active in the NPI registry since August 2018. The organization maintains 2 additional practice locations and lists Homer Ketcherside, President, as its authorized official.

NPPES Registry Identity

NPI1629557517
Entity TypeOrganization
Primary Taxonomy1223X0400X
Legal Business NameKETCHERSIDE DENTAL CORPORATION
Location Address720 MAGNOLIA AVE STE A1Corona, CA 92879-3119
Mailing Address400 W Stuart Ave Ste 110Redlands, CA 92374-3129 · (909) 793-1595
Fax(951) 737-3937
Organization SubpartNo
Authorized OfficialHomer KetchersidePresident · (909) 810-7167
Enumeration DateAugust 10, 2018
Last NPPES UpdateMay 11, 20202 updates tracked since enumeration
NPPES CertifiedMay 11, 2020
NPI 1629557517 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License Licensed in CA · 28872
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
720 MAGNOLIA AVE STE A1, Corona, CA 92879

Other Names 3

Doing Business AsPacking House District Dental & Orthodontics
Doing Business AsBrace Connection
Doing Business AsGary Ketcherside Orthodontics Inc

Secondary Practice Locations 2

Location 11468 Industrial Park AveRedlands, CA 92374-2892 · Phone (909) 793-1595 · Fax (909) 307-2154
Location 2400 W Stuart Ave Ste 110Redlands, CA 92374-3129 · Phone (909) 793-1595 · Fax (909) 307-2154

Other Identifiers 1

Other900937804CA · Tin

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ketcherside Dental Corporation's NPI number?

The NPI number for Ketcherside Dental Corporation is 1629557517. It was assigned to this organization in the NPPES registry on August 10, 2018. The provider is doing business as Packing House District Dental & Orthodontics, Brace Connection and Gary Ketcherside Orthodontics INC.

Where is Ketcherside Dental Corporation located?

Ketcherside Dental Corporation is located at 720 Magnolia Ave Ste A1, Corona, CA 92879. The listed phone number is (951) 737-3800.

What is Ketcherside Dental Corporation's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

When was this NPI record last updated?

The NPPES record for Ketcherside Dental Corporation was last updated on May 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.