Provider Demographics
NPI:1659849180
Name:TOTAL ORAL REHABILITATION AND COSMETIC DENTAL
Entity Type:Organization
Organization Name:TOTAL ORAL REHABILITATION AND COSMETIC DENTAL
Other - Org Name:TORC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-607-6500
Mailing Address - Street 1:2690 E. HWY 290,
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2690 E. HWY 290
Practice Address - Street 2:SUITE 400
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78260
Practice Address - Country:US
Practice Address - Phone:512-607-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental