Provider Demographics
NPI:1790228849
Name:A TSIBEL DDS DENTAL CORP
Entity Type:Organization
Organization Name:A TSIBEL DDS DENTAL CORP
Other - Org Name:LONG BEACH FAMILY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-439-6562
Mailing Address - Street 1:2211 E 7TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4515
Mailing Address - Country:US
Mailing Address - Phone:562-439-6562
Mailing Address - Fax:
Practice Address - Street 1:2211 E 7TH ST STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4515
Practice Address - Country:US
Practice Address - Phone:562-439-6562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental