Provider Demographics
NPI:1477700730
Name:EUSEBIO DENTAL CORPORATION
Entity Type:Organization
Organization Name:EUSEBIO DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EUSEBIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-336-6063
Mailing Address - Street 1:1127 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-336-6063
Mailing Address - Fax:619-336-6066
Practice Address - Street 1:1127 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-336-6063
Practice Address - Fax:619-336-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty