Provider Demographics
NPI:1659895910
Name:PINALES DDS DENTAL CORP
Entity Type:Organization
Organization Name:PINALES DDS DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:G
Authorized Official - Last Name:PINALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-550-7172
Mailing Address - Street 1:1217 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2640
Mailing Address - Country:US
Mailing Address - Phone:714-550-7172
Mailing Address - Fax:714-550-7173
Practice Address - Street 1:1217 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2640
Practice Address - Country:US
Practice Address - Phone:714-550-7172
Practice Address - Fax:714-550-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid