Healthcare Provider Details

I. General information

NPI: 1972660694
Provider Name (Legal Business Name): TORIN CHENARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23482 ALICIA PKWY
MISSION VIEJO CA
92691-2601
US

IV. Provider business mailing address

2409 RINDGE LN
REDONDO BEACH CA
90278-2417
US

V. Phone/Fax

Practice location:
  • Phone: 949-581-0090
  • Fax:
Mailing address:
  • Phone: 310-343-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: