Healthcare Provider Details

I. General information

NPI: 1689499204
Provider Name (Legal Business Name): SHELLAINE A DEL CAMPO AD SEDATION & IMPLANT DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY STE 220
IRVINE CA
92618-3176
US

IV. Provider business mailing address

113 WATERWORKS WAY STE 220
IRVINE CA
92618-3176
US

V. Phone/Fax

Practice location:
  • Phone: 949-418-3779
  • Fax:
Mailing address:
  • Phone: 949-418-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLAINE ALONSAGAY-DEL CAMPO
Title or Position: DOCTOR
Credential: DMD
Phone: 949-418-7339