Provider Demographics
NPI:1740985605
Name:TINOCO DENTAL CORP
Entity type:Organization
Organization Name:TINOCO DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-752-5413
Mailing Address - Street 1:1461 W GRAND AVE UNIT 3E
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2287
Mailing Address - Country:US
Mailing Address - Phone:805-888-4259
Mailing Address - Fax:805-888-2744
Practice Address - Street 1:1461 W GRAND AVE UNIT 3E
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2287
Practice Address - Country:US
Practice Address - Phone:805-888-4259
Practice Address - Fax:805-888-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty