Provider Demographics
NPI:1154621407
Name:TIBURCIO TING AND CHUNG PROF LLC
Entity type:Organization
Organization Name:TIBURCIO TING AND CHUNG PROF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPARTMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCHINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-2028
Mailing Address - Street 1:2101 S JONES BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3133
Mailing Address - Country:US
Mailing Address - Phone:702-522-2269
Mailing Address - Fax:702-990-8854
Practice Address - Street 1:5590 PAINTED MIRAGE RD
Practice Address - Street 2:STE. 140-150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-353-4081
Practice Address - Fax:702-947-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty