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805 W La Veta Ave Ste 200 Orange CA 92868-3929 | |
| (714) 532-9700 | |
| (714) 532-9766 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 805 W La Veta Ave Ste 200, Orange, California |
| Authorized Official Name and Position | Sage Monroe Humphries (OWNER/PRESIDENT) |
| Authorized Official Contact | 7149975961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
805 W La Veta Ave Ste 200 Orange CA 92868-3929 Ph: (714) 532-9700 | 805 W La Veta Ave Ste 200 Orange CA 92868-3929 Ph: (714) 532-9700 |
| NPI Number | 1598290819 |
|---|---|
| Provider Enumeration Date | 04/24/2017 |
| Last Update Date | 04/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598290819 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 53072 (California) | Primary |
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