Provider Demographics
NPI:1972152676
Name:DENTAL OFFICE OF ALBERT RINCON DDS INC.
Entity Type:Organization
Organization Name:DENTAL OFFICE OF ALBERT RINCON DDS INC.
Other - Org Name:RINCON DDS AND ASSOCIATES INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:951-674-4800
Mailing Address - Street 1:2503 E LAKESHORE DR STE E
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4433
Mailing Address - Country:US
Mailing Address - Phone:951-674-4800
Mailing Address - Fax:951-674-4833
Practice Address - Street 1:2503 E LAKESHORE DR STE E
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4433
Practice Address - Country:US
Practice Address - Phone:951-674-4800
Practice Address - Fax:951-674-4833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A RINCON DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-05
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty