Provider Demographics
NPI:1962791459
Name:PACIFI DENTAL CLINIC
Entity type:Organization
Organization Name:PACIFI DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-550-7172
Mailing Address - Street 1:1217 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2640
Mailing Address - Country:US
Mailing Address - Phone:714-550-7172
Mailing Address - Fax:714-550-7173
Practice Address - Street 1:1217 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2640
Practice Address - Country:US
Practice Address - Phone:714-550-7172
Practice Address - Fax:714-550-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty