Provider Demographics
NPI:1669647418
Name:R. TRENT TORGERSEN DDS, GINA TORGERSEN DDS INC.
Entity Type:Organization
Organization Name:R. TRENT TORGERSEN DDS, GINA TORGERSEN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:TORGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-527-4470
Mailing Address - Street 1:1975 ROYAL AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4656
Mailing Address - Country:US
Mailing Address - Phone:805-527-4470
Mailing Address - Fax:805-527-4482
Practice Address - Street 1:1975 ROYAL AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4656
Practice Address - Country:US
Practice Address - Phone:805-527-4470
Practice Address - Fax:805-527-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ0362051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty