Provider Demographics
NPI:1770036279
Name:TINOCO, ROBERTO ESTEVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ESTEVAN
Last Name:TINOCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2287
Mailing Address - Country:US
Mailing Address - Phone:805-825-7643
Mailing Address - Fax:805-888-2744
Practice Address - Street 1:1461 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2287
Practice Address - Country:US
Practice Address - Phone:805-825-7643
Practice Address - Fax:805-888-2744
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist