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General NPI Number Information
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NPI Number | 1023253127
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Entity Type | Organization
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Legal Business Name | PROCARE DENTAL GROUP, JOEY S. TIRADOR D.D.S. INC.
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 12602 AMARGOSA RD SUITE 'D'
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City | VICTORVILLE
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State | CA
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Zip | 92392-7640
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Country | US
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Telephone | 760-951-9997
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Fax | 760-962-9424
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Provider Business Mailing Address
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Address Line | 12602 AMARGOSA RD SUITE 'D'
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City | VICTORVILLE
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State | CA
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Zip | 92392-7640
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Country | US
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Telephone | 760-951-9997
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Fax | 760-962-9424
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. JOEY SORIANO TIRADOR
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Credential | DDS
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Telephone | 760-256-1189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | CA 50993
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License Number State | CA
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