Healthcare Provider Details

I. General information

NPI: 1639186000
Provider Name (Legal Business Name): JAMES PASSAMANO D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BARRANCA
IRVINE CA
92604-4741
US

IV. Provider business mailing address

4200 BARRANCA
IRVINE CA
92604-4741
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-5542
  • Fax:
Mailing address:
  • Phone: 949-552-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number26907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: