Provider Demographics
NPI:1508005729
Name:JAIME ACUNA LOERA, DDS, INC
Entity Type:Organization
Organization Name:JAIME ACUNA LOERA, DDS, INC
Other - Org Name:DENTAL ARTS OF PALM AVENUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ACUNA LOERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-424-3456
Mailing Address - Street 1:3388 PALM AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1662
Mailing Address - Country:US
Mailing Address - Phone:619-424-3456
Mailing Address - Fax:619-424-3455
Practice Address - Street 1:3388 PALM AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1662
Practice Address - Country:US
Practice Address - Phone:619-424-3456
Practice Address - Fax:619-424-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty