Homer Gary Ketcherside, DDS,MS - Medicare Dentist in Corona, CA

Homer Gary Ketcherside, DDS,MS is a medicare enrolled "Dentist - Orthodontics And Dentofacial Orthopedics" provider in Corona, California. His current practice location is 720 Magnolia Ave, Suite A1, Corona, California. You can reach out to his office (for appointments etc.) via phone at (951) 737-3800.

Homer Gary Ketcherside is licensed to practice in California (license number 28872) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1043570658.

Contact Information

Homer Gary Ketcherside, DDS,MS
720 Magnolia Ave, Suite A1,
Corona, CA 92879-3119
(951) 737-3800
(951) 737-3937



Healthcare Provider's Profile

Full NameHomer Gary Ketcherside
GenderMale
SpecialityDentist - Orthodontics And Dentofacial Orthopedics
Location720 Magnolia Ave, Corona, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1043570658
  • Provider Enumeration Date: 05/17/2012
  • Last Update Date: 07/22/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 9739491499
  • Enrollment ID: I20150709000041

Medical Identifiers

Medical identifiers for Homer Gary Ketcherside such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1043570658NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223X0400XDentist - Orthodontics And Dentofacial Orthopedics 28872 (California)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Homer Gary Ketcherside is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Homer Gary Ketcherside, DDS,MS
720 Magnolia Ave, Suite A1,
Corona, CA 92879-3119

Ph: (951) 737-3802
Homer Gary Ketcherside, DDS,MS
720 Magnolia Ave, Suite A1,
Corona, CA 92879-3119

Ph: (951) 737-3800

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Dentist in Corona, CA

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Phone: 951-278-8910    Fax: 951-278-9895
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Medicare: Not Enrolled in Medicare
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Phone: 951-737-5861    Fax: 951-737-5864
Peter O Escutin, DDS
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Practice Location: 3848 Mckinley Street, Suite D, Corona, CA 92879
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