Healthcare Provider Details

I. General information

NPI: 1306054655
Provider Name (Legal Business Name): HUNTINGTON BEACH CENTER FOR MAXILLOFACIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7891 TALBERT AVE SUITE 101
HUNTINGTON BEACH CA
92648-1319
US

IV. Provider business mailing address

7891 TALBERT AVE SUITE 101
HUNTINGTON BEACH CA
92648-1319
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-2521
  • Fax: 714-842-1083
Mailing address:
  • Phone: 714-842-2521
  • Fax: 714-842-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL E LEVIN
Title or Position: CEO
Credential: DDS
Phone: 714-842-2521