Provider Demographics
NPI:1689079550
Name:DINA ALEISSA D.D.S. INC.
Entity Type:Organization
Organization Name:DINA ALEISSA D.D.S. INC.
Other - Org Name:ORANGE GENTLE DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-997-5555
Mailing Address - Street 1:PO BOX 7133
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7133
Mailing Address - Country:US
Mailing Address - Phone:714-997-5555
Mailing Address - Fax:
Practice Address - Street 1:1330 N GLASSELL ST STE E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3628
Practice Address - Country:US
Practice Address - Phone:714-997-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty