Healthcare Provider Details

I. General information

NPI: 1255310603
Provider Name (Legal Business Name): LOMBARDI BROS DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR #200
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR #200
FOOTHILL RANCH CA
92610-2844
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 TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26465
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34993
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN LOMBARDI
Title or Position: OWNER/PARTNER
Credential: DDS
Phone: 949-830-3511