Provider Demographics
NPI:1538654421
Name:DINA ALEISSA DDS INC
Entity Type:Organization
Organization Name:DINA ALEISSA DDS INC
Other - Org Name:ORANGE GENTLE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-997-5555
Mailing Address - Street 1:1330 N GLASSELL ST STE E
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3628
Mailing Address - Country:US
Mailing Address - Phone:714-997-5555
Mailing Address - Fax:714-202-5936
Practice Address - Street 1:14261 JEFFREY RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3405
Practice Address - Country:US
Practice Address - Phone:714-997-5555
Practice Address - Fax:714-202-5936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DINA ALEISSA DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-25
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental