Healthcare Provider Details

I. General information

NPI: 1609649342
Provider Name (Legal Business Name): NASEM DUNLOP DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY STE 205
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

7 PAMELA WAY
COTO DE CAZA CA
92679-5145
US

V. Phone/Fax

Practice location:
  • Phone: 949-668-0686
  • Fax:
Mailing address:
  • Phone: 574-261-4071
  • 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. NASEM M DUNLOP
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 574-261-4071