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General NPI Number Information
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NPI Number | 1851126528
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Entity Type | Organization
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Legal Business Name | PRIMERODENTAL
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | MISION DE SAN JAVIER #10709-3
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City | TIJUANA
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State | BAJA CALIFORNIA
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Zip | 22010
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Country | MX
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Telephone | 619-565-1077
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Fax | 866-864-5572
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Provider Business Mailing Address
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Address Line | 4370 PALM AVE # D-637
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City | SAN DIEGO
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State | CA
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Zip | 92154-1760
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Country | US
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Telephone | 619-565-1077
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Fax | 866-864-5572
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Authorized Official
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Title or Position | PARTNER MGR.
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Name | MR. LUIS ANTONIO TORAYA
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Credential | DDS
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Telephone | 619-565-1077
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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 |
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License Number State |
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