Provider Demographics
NPI:1073399218
Name:TWIN PEAKS DENTAL PARTNERS LLC
Entity Type:Organization
Organization Name:TWIN PEAKS DENTAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:7475 W TWIN PEAKS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1534
Mailing Address - Country:US
Mailing Address - Phone:520-579-1500
Mailing Address - Fax:
Practice Address - Street 1:7475 W TWIN PEAKS RD STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-1534
Practice Address - Country:US
Practice Address - Phone:520-579-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty