| |
2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 | |
(949) 515-9280 | |
(949) 515-9289 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 2263 Fairview Rd Ste K, Costa Mesa, California |
Authorized Official Name and Position | Derek Dungquang Duong (PRESIDENT) |
Authorized Official Contact | 9495159280 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 Ph: (949) 515-9280 | 2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 Ph: (949) 515-9280 |
NPI Number | 1144370768 |
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Provider Enumeration Date | 01/12/2007 |
Last Update Date | 12/29/2017 |
Identifier | Type | State | Issuer |
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1144370768 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 48906 (California) | Primary |
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