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113 W Amerige Ave Fullerton CA 92832-1856 | |
| (714) 525-1178 | |
| (714) 879-6235 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 113 W Amerige Ave, Fullerton, California |
| Authorized Official Name and Position | Steven A Miyamoto (OWNER) |
| Authorized Official Contact | 7145251178 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
113 W Amerige Ave Fullerton CA 92832-1856 Ph: (714) 525-1178 | 113 W Amerige Ave Fullerton CA 92832-1856 Ph: (714) 525-1178 |
| NPI Number | 1477090744 |
|---|---|
| Provider Enumeration Date | 01/25/2017 |
| Last Update Date | 01/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477090744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 42368 (California) | Primary |
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