Healthcare Provider Details

I. General information

NPI: 1821077348
Provider Name (Legal Business Name): AARON J NOORDMANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON ATTN DENTAL DEPARTMENT
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

318 KEYPORT ST
OCEANSIDE CA
92057-4263
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-3939
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: