Healthcare Provider Details

I. General information

NPI: 1447012653
Provider Name (Legal Business Name): A. TSIBEL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E 7TH STREET SUITE C
LONG BEACH CA
90804-4515
US

IV. Provider business mailing address

2211 E 7TH STREET SUITE C
LONG BEACH CA
90804-4515
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-6562
  • Fax: 562-375-6632
Mailing address:
  • Phone: 562-439-6562
  • Fax: 562-375-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARKADY S TSIBEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 562-439-6562