Provider Demographics
NPI:1598103947
Name:ALEISSA, DINA (DDS)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ALEISSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 RAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6606
Mailing Address - Country:US
Mailing Address - Phone:714-234-6149
Mailing Address - Fax:714-276-6164
Practice Address - Street 1:3502 RAWLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-6606
Practice Address - Country:US
Practice Address - Phone:714-234-6149
Practice Address - Fax:714-276-6164
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist