Provider Demographics
NPI:1700626116
Name:NORTH TUSTIN DENTAL SPECIALTY CENTER INC
Entity type:Organization
Organization Name:NORTH TUSTIN DENTAL SPECIALTY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-375-0656
Mailing Address - Street 1:1245 W HUNTINGTON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6384
Mailing Address - Country:US
Mailing Address - Phone:626-898-9787
Mailing Address - Fax:
Practice Address - Street 1:18102 IRVINE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3414
Practice Address - Country:US
Practice Address - Phone:714-838-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty