Provider Demographics
NPI:1548804313
Name:SAMBATH TIEP DDS, PC
Entity Type:Organization
Organization Name:SAMBATH TIEP DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMBATH
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-251-3313
Mailing Address - Street 1:15725 POMERADO RD STE 206
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2059
Mailing Address - Country:US
Mailing Address - Phone:858-251-3313
Mailing Address - Fax:
Practice Address - Street 1:15725 POMERADO RD STE 206
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2059
Practice Address - Country:US
Practice Address - Phone:858-251-3313
Practice Address - Fax:858-225-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty