Provider Demographics
NPI:1255129789
Name:ALEISSA DDS A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:ALEISSA DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-997-5555
Mailing Address - Street 1:1330 N GLASSELL ST STE E
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3628
Mailing Address - Country:US
Mailing Address - Phone:714-997-5555
Mailing Address - Fax:714-202-5936
Practice Address - Street 1:1330 N GLASSELL ST STE E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3628
Practice Address - Country:US
Practice Address - Phone:714-997-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental