Healthcare Provider Details

I. General information

NPI: 1558482158
Provider Name (Legal Business Name): GREGORIO V. TOLENTINO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 OCEANSIDE BLVD SUITE M
OCEANSIDE CA
92054-4423
US

IV. Provider business mailing address

1906 OCEANSIDE BLVD SUITE M
OCEANSIDE CA
92054-4423
US

V. Phone/Fax

Practice location:
  • Phone: 760-433-1725
  • Fax: 760-433-1705
Mailing address:
  • Phone: 760-433-1725
  • Fax: 760-433-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: