Provider Demographics
NPI:1063632123
Name:TABA APOSTU & APOSTU PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:TABA APOSTU & APOSTU PROFESSIONAL DENTAL CORP
Other - Org Name:TUSCANG DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:APOSTU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:751-471-1400
Mailing Address - Street 1:361 RAILROAD CANYON RD
Mailing Address - Street 2:#A
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532
Mailing Address - Country:US
Mailing Address - Phone:951-471-1400
Mailing Address - Fax:951-471-1403
Practice Address - Street 1:361 RAILROAD CANYON RD
Practice Address - Street 2:#A
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532
Practice Address - Country:US
Practice Address - Phone:951-471-1400
Practice Address - Fax:951-471-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9148101Medicaid