| Lake Forest Modern Dental | |
|
23642 Rockfield Blvd Ste 504 Lake Forest CA 92630-1681 | |
| (949) 415-7776 | |
| (949) 916-9906 |
| Full Name | Lake Forest Modern Dental |
|---|---|
| Speciality | Dentist |
| Location | 23642 Rockfield Blvd, Lake Forest, California |
| Authorized Official Name and Position | Sean Nguyen (PRESIDENT) |
| Authorized Official Contact | 9494157776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Forest Modern Dental 23642 Rockfield Blvd Ste 504 Lake Forest CA 92630-1681 Ph: (949) 415-7776 | Lake Forest Modern Dental 23642 Rockfield Blvd Ste 504 Lake Forest CA 92630-1681 Ph: (949) 415-7776 |
| NPI Number | 1902348717 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 11/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902348717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 58399 (California) | Primary |
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