Provider Demographics
NPI:1396728218
Name:ALTSHUL DENTAL CORP
Entity type:Organization
Organization Name:ALTSHUL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALTSHUL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-630-4705
Mailing Address - Street 1:2023 W VISTA WAY
Mailing Address - Street 2:SUITE P
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-630-4705
Mailing Address - Fax:760-630-4609
Practice Address - Street 1:2023 W VISTA WAY
Practice Address - Street 2:SUITE P
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:760-630-4705
Practice Address - Fax:760-630-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310191223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty