Provider Demographics
NPI: | 1164693669 |
---|---|
Name: | TRAMONTO DENTAL GROUP, LLP |
Entity Type: | Organization |
Organization Name: | TRAMONTO DENTAL GROUP, LLP |
Other - Org Name: | TRAMONTO DENTAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | GEBHART |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 623-879-9503 |
Mailing Address - Street 1: | 2860 MICHELLE |
Mailing Address - Street 2: | 2ND FLOOR |
Mailing Address - City: | IRVINE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92606-1009 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-508-3600 |
Mailing Address - Fax: | 714-368-2092 |
Practice Address - Street 1: | 34640 N NORTH VALLEY PKWY |
Practice Address - Street 2: | SUITE 104 |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85086-3247 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-879-9503 |
Practice Address - Fax: | 623-587-6453 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-12 |
Last Update Date: | 2010-10-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |