Provider Demographics
NPI:1710195243
Name:MARITESS TINOCO, DDS AND DIANA SIMBOL, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARITESS TINOCO, DDS AND DIANA SIMBOL, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:GENTLE CARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMBOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-530-1175
Mailing Address - Street 1:1403 W. LOMITA BLVD. SUITE 306
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 W. LOMITA BLVD. SUITE 306
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:310-530-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty