Provider Demographics
NPI:1871633172
Name:MISAKO HIROTA DMD A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MISAKO HIROTA DMD A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MISAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-474-4695
Mailing Address - Street 1:219 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2224
Mailing Address - Country:US
Mailing Address - Phone:619-474-4695
Mailing Address - Fax:619-474-2984
Practice Address - Street 1:219 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2224
Practice Address - Country:US
Practice Address - Phone:619-474-4695
Practice Address - Fax:619-474-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADE351171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92697 01Medicaid
CA=========OtherTIN