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General NPI Number Information
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NPI Number | 1477029502
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Entity Type | Organization
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Legal Business Name | TIBBITTS TEMECULA DENTAL GROUP
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 32909 TEMECULA PARKWAY STE 102
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City | TEMECULA
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State | CA
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Zip | 92592
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Country | US
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Telephone | 951-972-8080
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Fax | 951-395-0301
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Provider Business Mailing Address
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Address Line | 32909 TEMECULA PKWY STE 102
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City | TEMECULA
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State | CA
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Zip | 92592-6907
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Country | US
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Telephone | 951-972-8080
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Fax | 951-972-8080
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VALERIE A ROGERS
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Credential |
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Telephone | 951-677-5113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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