Provider Demographics
NPI:1972667566
Name:TOLENTINO, ROSEGEN TEJANO (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSEGEN
Middle Name:TEJANO
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 PACIFIC AVE STE M
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2627
Mailing Address - Country:US
Mailing Address - Phone:562-426-9390
Mailing Address - Fax:562-426-9589
Practice Address - Street 1:2777 PACIFIC AVE STE M
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2627
Practice Address - Country:US
Practice Address - Phone:562-426-9390
Practice Address - Fax:562-426-9589
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist