Healthcare Provider Details

I. General information

NPI: 1477029502
Provider Name (Legal Business Name): TIBBITTS TEMECULA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32909 TEMECULA PARKWAY STE 102
TEMECULA CA
92592
US

IV. Provider business mailing address

32909 TEMECULA PKWY STE 102
TEMECULA CA
92592-6907
US

V. Phone/Fax

Practice location:
  • Phone: 951-972-8080
  • Fax: 951-395-0301
Mailing address:
  • Phone: 951-972-8080
  • Fax: 951-972-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE A ROGERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-677-5113