MEDICARE: LENTEJAS DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	46098	CA

General Provider Information

NPI Number	:	1548626344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENTEJAS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	31571 CANYON ESTATES DR
Second Line	:	SUITE 208
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0468
Country	:	US
Telephone Number	:	951-245-4900
Fax Number	:	951-525-4499

Provider Business Practice Location Address
First Line	:	31571 CANYON ESTATES DR
Second Line	:	SUITE 208
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92532-0468
Country	:	US
Telephone Number	:	951-245-4900
Fax Number	:	951-525-4499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIET LENTEJAS
Credential	:	DMD
Telephone Number	:	951-214-8787

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	01/08/2016

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