Healthcare Provider Details

I. General information

NPI: 1104586593
Provider Name (Legal Business Name): SELINA SARNO, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 200
FOOTHILL RANCH CA
92610-2845
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 200
FOOTHILL RANCH CA
92610-2845
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-3511
  • Fax: 949-830-0997
Mailing address:
  • Phone: 949-830-3511
  • Fax: 949-830-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SELINA ANN S SARNO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 562-704-8783