Healthcare Provider Details

I. General information

NPI: 1972152676
Provider Name (Legal Business Name): DENTAL OFFICE OF ALBERT RINCON DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 E LAKESHORE DR STE E
LAKE ELSINORE CA
92530-4433
US

IV. Provider business mailing address

2503 E LAKESHORE DR STE E
LAKE ELSINORE CA
92530-4433
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-4800
  • Fax: 951-674-4833
Mailing address:
  • Phone: 951-674-4800
  • Fax: 951-674-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA E WELBOURNE
Title or Position: OFFICE MANAGER
Credential: M.A.ED
Phone: 951-674-4800