Healthcare Provider Details

I. General information

NPI: 1174796007
Provider Name (Legal Business Name): ORANGE COAST DENTAL SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20932 BROOKHURST ST SUITE #202
HUNTINGTON BEACH CA
92646-6638
US

IV. Provider business mailing address

20932 BROOKHURST ST SUITE #202
HUNTINGTON BEACH CA
92646-6638
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-5500
  • Fax: 714-968-5503
Mailing address:
  • Phone: 714-968-5500
  • Fax: 714-968-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number54847
License Number StateCA

VIII. Authorized Official

Name: DR. DEAN DAI
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-968-5500