Provider Demographics
NPI:1801034418
Name:JOEY S. TIRADOR, DDS, INC.
Entity Type:Organization
Organization Name:JOEY S. TIRADOR, DDS, INC.
Other - Org Name:PROCARE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:SORIANO
Authorized Official - Last Name:TIRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-256-1189
Mailing Address - Street 1:1232 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2409
Mailing Address - Country:US
Mailing Address - Phone:760-256-1189
Mailing Address - Fax:760-256-1427
Practice Address - Street 1:1232 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2409
Practice Address - Country:US
Practice Address - Phone:760-256-1189
Practice Address - Fax:760-256-1427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1538343470
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94083-02OtherDENTI-CAL