Healthcare Provider Details

I. General information

NPI: 1619243094
Provider Name (Legal Business Name): HARBOUR DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 WARNER AVENUE
HUNTINGTON BEACH CA
92649
US

IV. Provider business mailing address

5219 WARNER AVENUE
HUNTINGTON BEACH CA
92649
US

V. Phone/Fax

Practice location:
  • Phone: 714-846-0000
  • Fax: 714-846-0088
Mailing address:
  • Phone: 714-846-0000
  • Fax: 714-846-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45936
License Number StateCA

VIII. Authorized Official

Name: ANTHONY NGO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 702-580-1273