| South Oc Pediatric Dentistry & Orthodontics | |
|
26302 La Paz Rd Ste 114 Mission Viejo CA 92691-5327 | |
| (949) 581-5800 | |
| (949) 581-6794 |
| Full Name | South Oc Pediatric Dentistry & Orthodontics |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 26302 La Paz Rd, Mission Viejo, California |
| Authorized Official Name and Position | John Dennis De Lorme (DENTIST/OWNER) |
| Authorized Official Contact | 9495815800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Oc Pediatric Dentistry & Orthodontics 26302 La Paz Rd Ste 114 Mission Viejo CA 92691-5327 Ph: (949) 581-5800 | South Oc Pediatric Dentistry & Orthodontics 26302 La Paz Rd Ste 114 Mission Viejo CA 92691-5327 Ph: (949) 581-5800 |
| NPI Number | 1891790390 |
|---|---|
| Provider Enumeration Date | 06/20/2005 |
| Last Update Date | 09/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891790390 | NPI | - | NPPES |
| B2321401 | Other | CA | DENTICAL |
| D23214 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | O-118872-L (California) | Primary |
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