Provider Demographics
NPI:1023857976
Name:ALLA PATISH-PREOBRAZHENSKAYA DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALLA PATISH-PREOBRAZHENSKAYA DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATISH-PREOBRAZHENSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-384-9444
Mailing Address - Street 1:815 COLLEGE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 COLLEGE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6261
Practice Address - Country:US
Practice Address - Phone:760-306-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty