Provider Demographics
NPI:1336348838
Name:LENTEJAS DENTAL CORPORATION
Entity Type:Organization
Organization Name:LENTEJAS DENTAL CORPORATION
Other - Org Name:DISCOVERY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:P
Authorized Official - Last Name:LENTEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-653-2100
Mailing Address - Street 1:14114 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9113
Mailing Address - Country:US
Mailing Address - Phone:951-653-2100
Mailing Address - Fax:951-977-4104
Practice Address - Street 1:14114 BUSINESS CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9113
Practice Address - Country:US
Practice Address - Phone:951-653-2100
Practice Address - Fax:951-653-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty