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1401 Avocado Ave. Suite 506 Newport Beach CA 92660 | |
| (949) 760-1661 | |
| (949) 760-8016 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1401 Avocado Ave. Suite 506, Newport Beach, California |
| Authorized Official Name and Position | Thomas Raymond Michaelis (PARTNER) |
| Authorized Official Contact | 9497601661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1401 Avocado Ave. Suite 506 Newport Beach CA 92660 Ph: (949) 760-1661 | 1401 Avocado Ave. Suite 506 Newport Beach CA 92660 Ph: (949) 760-1661 |
| NPI Number | 1356892657 |
|---|---|
| Provider Enumeration Date | 10/21/2016 |
| Last Update Date | 01/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356892657 | NPI | - | NPPES |
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