Provider Demographics
NPI:1811162662
Name:R. TRENT TORGERSEN DDS, GINA TORGERSEN DDS, INC.
Entity type:Organization
Organization Name:R. TRENT TORGERSEN DDS, GINA TORGERSEN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-484-1221
Mailing Address - Street 1:484 MOBIL AVE
Mailing Address - Street 2:SUITE #31
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6303
Mailing Address - Country:US
Mailing Address - Phone:805-484-1221
Mailing Address - Fax:805-389-0900
Practice Address - Street 1:484 MOBIL AVE
Practice Address - Street 2:SUITE #31
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6303
Practice Address - Country:US
Practice Address - Phone:805-484-1221
Practice Address - Fax:805-389-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG0362041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty