Provider Demographics
NPI:1265636112
Name:LONNIE W. TINER, DDS, APC
Entity Type:Organization
Organization Name:LONNIE W. TINER, DDS, APC
Other - Org Name:HI-DESERT ORAL & MAXILLOFACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-365-0658
Mailing Address - Street 1:56669 29 PALMS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5219
Mailing Address - Country:US
Mailing Address - Phone:760-365-0658
Mailing Address - Fax:760-365-5308
Practice Address - Street 1:56669 29 PALMS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5219
Practice Address - Country:US
Practice Address - Phone:760-365-0658
Practice Address - Fax:760-365-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9196501Medicaid