Provider Demographics
NPI:1245629666
Name:PETER M SINCLAIR, DDS A PROFESSIONAL DENTAL CORPOR
Entity type:Organization
Organization Name:PETER M SINCLAIR, DDS A PROFESSIONAL DENTAL CORPOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-375-0001
Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-375-0001
Mailing Address - Fax:310-373-8405
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-375-0001
Practice Address - Fax:310-373-8405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER M SINCLAIR DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty