Healthcare Provider Details

I. General information

NPI: 1013163385
Provider Name (Legal Business Name): GAFF DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 BRISTOL ST STE AA
COSTA MESA CA
92626-3001
US

IV. Provider business mailing address

3033 BRISTOL ST STE AA
COSTA MESA CA
92626-3001
US

V. Phone/Fax

Practice location:
  • Phone: 714-424-9099
  • Fax:
Mailing address:
  • Phone: 714-424-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53334
License Number StateCA

VIII. Authorized Official

Name: MRS. NAZITA GAFF
Title or Position: DENTIST
Credential: DMD
Phone: 714-424-9099