Provider Demographics
NPI:1083892558
Name:TELLO MOTTA, JORGE ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:TELLO MOTTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16465 SIERRA LAKES PKWY STE 255
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1264
Mailing Address - Country:US
Mailing Address - Phone:909-350-0770
Mailing Address - Fax:909-350-0770
Practice Address - Street 1:TINY TOTS DENTAL
Practice Address - Street 2:7705 S. ATLANTIC AVE SUITE B
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5085
Practice Address - Country:US
Practice Address - Phone:323-773-1664
Practice Address - Fax:323-773-7365
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist