Provider Demographics
NPI:1265821235
Name:PETER ESCUTIN DDS INC
Entity Type:Organization
Organization Name:PETER ESCUTIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-371-2424
Mailing Address - Street 1:3848 N MCKINLEY ST STE D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-6113
Mailing Address - Country:US
Mailing Address - Phone:951-371-2424
Mailing Address - Fax:951-371-2423
Practice Address - Street 1:3848 N MCKINLEY ST STE D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6113
Practice Address - Country:US
Practice Address - Phone:951-371-2424
Practice Address - Fax:951-371-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty