Provider Demographics
NPI:1740466580
Name:JAIME ACUNA LOERA, DDS DENTAL CORP
Entity type:Organization
Organization Name:JAIME ACUNA LOERA, DDS DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:619-429-5959
Mailing Address - Street 1:2987 CORONADO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2180
Mailing Address - Country:US
Mailing Address - Phone:619-429-5959
Mailing Address - Fax:619-429-9438
Practice Address - Street 1:2987 CORONADO AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2180
Practice Address - Country:US
Practice Address - Phone:619-429-5959
Practice Address - Fax:619-429-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty