Provider Demographics
NPI:1982023792
Name:ADA GRUITA, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ADA GRUITA, A DENTAL CORPORATION
Other - Org Name:PRO HEALTH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-525-8238
Mailing Address - Street 1:15 SAINT PIERRE
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3724
Mailing Address - Country:US
Mailing Address - Phone:949-525-8238
Mailing Address - Fax:
Practice Address - Street 1:27680 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6674
Practice Address - Country:US
Practice Address - Phone:949-916-6868
Practice Address - Fax:949-916-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty