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100 E Valencia Mesa Dr Suite 102 Fullerton CA 92835-3813 | |
| (714) 992-5437 | |
| (714) 870-3085 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 100 E Valencia Mesa Dr, Fullerton, California |
| Authorized Official Name and Position | Richard S Lee (PRESIDENT) |
| Authorized Official Contact | 7149925437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 E Valencia Mesa Dr Suite 102 Fullerton CA 92835-3813 Ph: (714) 992-5437 | 100 E Valencia Mesa Dr Suite 102 Fullerton CA 92835-3813 Ph: (714) 992-5437 |
| NPI Number | 1871624387 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871624387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 44807 (California) | Primary |
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