Provider Demographics
NPI:1538343470
Name:PROCARE DENTAL GROUP, JOEY S. TIRADOR D.D.S. INC.
Entity type:Organization
Organization Name:PROCARE DENTAL GROUP, JOEY S. TIRADOR D.D.S. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:SORIANO
Authorized Official - Last Name:TIRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-256-1189
Mailing Address - Street 1:1232 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2409
Mailing Address - Country:US
Mailing Address - Phone:760-256-1189
Mailing Address - Fax:760-256-1427
Practice Address - Street 1:1232 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2409
Practice Address - Country:US
Practice Address - Phone:760-256-1189
Practice Address - Fax:760-256-1427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1232 E. MAIN STREET, BARSTOW, CA 92311
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356565923OtherNPI