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General NPI Number Information
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NPI Number | 1538609243
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Entity Type | Organization
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Legal Business Name | TUSTIN DENTAL CARE
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 275 CENTENNIAL WAY STE 109
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City | TUSTIN
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State | CA
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Zip | 92780-3708
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Country | US
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Telephone | 714-832-8089
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Fax | 657-323-1887
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Provider Business Mailing Address
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Address Line | 275 CENTENNIAL WAY STE 109
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City | TUSTIN
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State | CA
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Zip | 92780-3708
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Country | US
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Telephone | 714-832-8089
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Fax | 657-323-1887
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | PATTY BARTON
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Credential |
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Telephone | 562-905-8338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 37769
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License Number State | CA
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