Provider Demographics
NPI:1851126528
Name:PRIMERODENTAL
Entity type:Organization
Organization Name:PRIMERODENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER MGR.
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:TORAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-565-1077
Mailing Address - Street 1:4370 PALM AVE # D-637
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1760
Mailing Address - Country:US
Mailing Address - Phone:619-565-1077
Mailing Address - Fax:866-864-5572
Practice Address - Street 1:MISION DE SAN JAVIER #10709-3
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:619-565-1077
Practice Address - Fax:866-864-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty