Provider Demographics
NPI:1932348430
Name:TRIFF, EUGENE NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:NICHOLAS
Last Name:TRIFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:E
Other - Middle Name:NICHOLAS
Other - Last Name:TRIFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5028 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2802
Mailing Address - Country:US
Mailing Address - Phone:562-431-4407
Mailing Address - Fax:562-431-1745
Practice Address - Street 1:5028 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-431-4407
Practice Address - Fax:562-431-1745
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122300000XOtherTAXONOMY