Provider Demographics
NPI:1447472691
Name:IRENE M. TING D.M.D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IRENE M. TING D.M.D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:MALABANAN
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-397-7162
Mailing Address - Street 1:668 EL PORTAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914
Mailing Address - Country:US
Mailing Address - Phone:619-216-1783
Mailing Address - Fax:
Practice Address - Street 1:885 CANARIOS COURT #212
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-397-7162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty