Provider Demographics
NPI:1093980732
Name:DELUNA ALARCON DENTAL CORPORATION
Entity Type:Organization
Organization Name:DELUNA ALARCON DENTAL CORPORATION
Other - Org Name:GRAND SMILES FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE EMMANUEL
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:DE LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-734-6829
Mailing Address - Street 1:3643 GRAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2336
Mailing Address - Country:US
Mailing Address - Phone:760-734-6829
Mailing Address - Fax:760-734-6839
Practice Address - Street 1:3643 GRAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2336
Practice Address - Country:US
Practice Address - Phone:760-734-6829
Practice Address - Fax:760-734-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477111223G0001X
CA407811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty