Provider Demographics
NPI:1548626344
Name:LENTEJAS DENTAL CORPORATION
Entity type:Organization
Organization Name:LENTEJAS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-214-8787
Mailing Address - Street 1:31571 CANYON ESTATES DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0468
Mailing Address - Country:US
Mailing Address - Phone:951-245-4900
Mailing Address - Fax:951-525-4499
Practice Address - Street 1:31571 CANYON ESTATES DR
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0468
Practice Address - Country:US
Practice Address - Phone:951-245-4900
Practice Address - Fax:951-525-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty