Provider Demographics
NPI:1144728684
Name:IRVINE DENTISTRY
Entity type:Organization
Organization Name:IRVINE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-552-1757
Mailing Address - Street 1:5394 WALNUT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2544
Mailing Address - Country:US
Mailing Address - Phone:949-552-1757
Mailing Address - Fax:949-552-5821
Practice Address - Street 1:5394 WALNUT AVE STE E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2544
Practice Address - Country:US
Practice Address - Phone:949-552-1757
Practice Address - Fax:949-552-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty