Provider Demographics
NPI:1245342542
Name:RIVER OAK DENTAL SPA DENTAL OFFICE OF TOURTLOTTE DENTAL CORPORATION
Entity type:Organization
Organization Name:RIVER OAK DENTAL SPA DENTAL OFFICE OF TOURTLOTTE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TOURTLOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-848-8074
Mailing Address - Street 1:1473 EAST G ST
Mailing Address - Street 2:STE C
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361
Mailing Address - Country:US
Mailing Address - Phone:209-848-8074
Mailing Address - Fax:
Practice Address - Street 1:1473 EAST G ST
Practice Address - Street 2:STE C
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-848-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty