Healthcare Provider Details

I. General information

NPI: 1386171536
Provider Name (Legal Business Name): SKZAND DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 104
FOOTHILL RANCH CA
92610-2842
US

IV. Provider business mailing address

26730 TOWNE CENTRE DR STE 104
FOOTHILL RANCH CA
92610-2842
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. SUSAN ZAND
Title or Position: ORTHODONTIST
Credential:
Phone: 949-973-0490