Healthcare Provider Details

I. General information

NPI: 1073232997
Provider Name (Legal Business Name): DENTAL OFFICE OF JOEL HENRIOD DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17762 BEACH BLVD STE 210
HUNTINGTON BEACH CA
92647-6860
US

IV. Provider business mailing address

17762 BEACH BLVD STE 210
HUNTINGTON BEACH CA
92647-6860
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-2517
  • Fax:
Mailing address:
  • Phone: 714-898-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TWYLA M PARDON
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 714-420-0952