Healthcare Provider Details

I. General information

NPI: 1457866824
Provider Name (Legal Business Name): ADRIANA LALINDE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 LIGHTHOUSE AVE
PACIFIC GROVE CA
93950-2522
US

IV. Provider business mailing address

712 LIGHTHOUSE AVE
PACIFIC GROVE CA
93950-2522
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4942
  • Fax: 831-375-2960
Mailing address:
  • Phone: 831-375-4942
  • Fax: 831-375-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48817
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA LALINDE
Title or Position: OWNER
Credential: DDS
Phone: 831-375-4942