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120 Tustin Ave C252 Newport Beach CA 92663-4729 | |
| (702) 370-1644 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 120 Tustin Ave, Newport Beach, California |
| Authorized Official Name and Position | Corey Corpodian (OWNER/DOCTOR/PRESIDENT) |
| Authorized Official Contact | 7023701644 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
120 Tustin Ave C252 Newport Beach CA 92663-4729 Ph: (702) 370-1644 | 120 Tustin Ave C252 Newport Beach CA 92663-4729 Ph: (702) 370-1644 |
| NPI Number | 1447675368 |
|---|---|
| Provider Enumeration Date | 02/28/2014 |
| Last Update Date | 05/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447675368 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 62505 (California) | Primary |
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