Healthcare Provider Details

I. General information

NPI: 1083149942
Provider Name (Legal Business Name): ROAR ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 405
MISSION VIEJO CA
92691-8022
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 405
MISSION VIEJO CA
92691-8022
US

V. Phone/Fax

Practice location:
  • Phone: 949-448-7667
  • Fax: 949-586-6525
Mailing address:
  • Phone: 949-448-7667
  • Fax: 949-586-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GANNON KA LEE
Title or Position: OWNER
Credential: DDS
Phone: 949-448-7667