Healthcare Provider Details

I. General information

NPI: 1790651636
Provider Name (Legal Business Name): POLIRAN DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 W ORANGETHORPE AVE
FULLERTON CA
92832-2827
US

IV. Provider business mailing address

942 W ORANGETHORPE AVE
FULLERTON CA
92832-2827
US

V. Phone/Fax

Practice location:
  • Phone: 714-525-1130
  • Fax:
Mailing address:
  • Phone: 714-525-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NELSON S POLIRAN JR.
Title or Position: DENTIST, OWNER
Credential: DDS, MS
Phone: 626-241-5206