Provider Demographics
NPI:1538609243
Name:TUSTIN DENTAL CARE
Entity type:Organization
Organization Name:TUSTIN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-905-8338
Mailing Address - Street 1:275 CENTENNIAL WAY
Mailing Address - Street 2:STE 109
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3708
Mailing Address - Country:US
Mailing Address - Phone:714-832-8089
Mailing Address - Fax:657-323-1887
Practice Address - Street 1:275 CENTENNIAL WAY
Practice Address - Street 2:STE 109
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3708
Practice Address - Country:US
Practice Address - Phone:714-832-8089
Practice Address - Fax:657-323-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty