Provider Demographics
NPI:1144383639
Name:ST JOSEPH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ST JOSEPH FAMILY DENTISTRY
Other - Org Name:DENNIS L TIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LIM
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-891-0888
Mailing Address - Street 1:2827 WHITSON
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662
Mailing Address - Country:US
Mailing Address - Phone:559-891-0888
Mailing Address - Fax:559-891-8546
Practice Address - Street 1:2827 WHITSON
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662
Practice Address - Country:US
Practice Address - Phone:559-891-0888
Practice Address - Fax:559-891-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9172601OtherMEDICAL
CAG980111OtherHEALTHY FAMILIES