Provider Demographics
NPI:1548509862
Name:M HIROTA DMD A DENTAL CORPORATION
Entity type:Organization
Organization Name:M HIROTA DMD A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:HIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-474-4695
Mailing Address - Street 1:135 CIVIC CENTER DR
Mailing Address - Street 2:102
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4357
Mailing Address - Country:US
Mailing Address - Phone:619-474-4695
Mailing Address - Fax:619-252-4935
Practice Address - Street 1:135 CIVIC CENTER DR
Practice Address - Street 2:102
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4357
Practice Address - Country:US
Practice Address - Phone:619-474-4695
Practice Address - Fax:619-252-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty