Healthcare Provider Details

I. General information

NPI: 1528069135
Provider Name (Legal Business Name): WANDA IRENE CLARO DDS, MS, INC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OSBORN ST SUITE 180
IRVINE CA
92604-4690
US

IV. Provider business mailing address

2 OSBORN ST SUITE 180
IRVINE CA
92604-4690
US

V. Phone/Fax

Practice location:
  • Phone: 949-786-7800
  • Fax: 949-786-3881
Mailing address:
  • Phone: 949-786-7800
  • Fax: 949-786-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: