Provider Demographics
NPI:1356565923
Name:TIRADOR, JOEY SORIANO (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEY
Middle Name:SORIANO
Last Name:TIRADOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:SORIANO
Other - Last Name:TIRADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1232 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2409
Mailing Address - Country:US
Mailing Address - Phone:760-256-1189
Mailing Address - Fax:760-256-1427
Practice Address - Street 1:1232 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2409
Practice Address - Country:US
Practice Address - Phone:760-256-1189
Practice Address - Fax:760-256-1427
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice