| Grace Dominica Dy Dds Inc | |
|
2010 N Tustin St Ste A Orange CA 92865-3900 | |
| (714) 282-0430 | |
| Not Available |
| Full Name | Grace Dominica Dy Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 2010 N Tustin St Ste A, Orange, California |
| Authorized Official Name and Position | Grace Dy (CEO) |
| Authorized Official Contact | 7142820430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Dominica Dy Dds Inc 2010 N Tustin St Ste A Orange CA 92865-3900 Ph: () - | Grace Dominica Dy Dds Inc 2010 N Tustin St Ste A Orange CA 92865-3900 Ph: (714) 282-0430 |
| NPI Number | 1114282142 |
|---|---|
| Provider Enumeration Date | 07/05/2012 |
| Last Update Date | 07/05/2012 |
| Medicare PECOS PAC ID | 8325371610 |
|---|---|
| Medicare Enrollment ID | O20190530002397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114282142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 56567 (California) | Primary |
| Provider Name | Grace Noble Dy |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1235319344 PECOS PAC ID: 6305189697 Enrollment ID: I20190530002150 |
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