Provider Demographics
NPI:1629518691
Name:J ACUNA LOERA DENTAL CORPORATION INC
Entity Type:Organization
Organization Name:J ACUNA LOERA DENTAL CORPORATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ACUNA LOERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-424-3456
Mailing Address - Street 1:8300 PARADISE VALLEY RD STE 122
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6214
Mailing Address - Country:US
Mailing Address - Phone:619-479-9143
Mailing Address - Fax:
Practice Address - Street 1:8300 PARADISE VALLEY RD STE 122
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6214
Practice Address - Country:US
Practice Address - Phone:619-479-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty