Healthcare Provider Details

I. General information

NPI: 1801351986
Provider Name (Legal Business Name): CHESTNUT DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 CHESTNUT ST
LOS ALAMITOS CA
90720-2378
US

IV. Provider business mailing address

10951 CHESTNUT ST
LOS ALAMITOS CA
90720-2378
US

V. Phone/Fax

Practice location:
  • Phone: 562-594-8769
  • Fax: 562-594-5631
Mailing address:
  • Phone: 562-594-8769
  • Fax: 562-594-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA LYNN AUXIER
Title or Position: PRESIDENT
Credential: DMD
Phone: 562-594-8769