Healthcare Provider Details

I. General information

NPI: 1053260281
Provider Name (Legal Business Name): RES DENTAL NEWPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JAMBOREE RD SUITE 280
NEWPORT BEACH CA
92660-2939
US

IV. Provider business mailing address

3501 JAMBOREE RD SUITE 280
NEWPORT BEACH CA
92660-2939
US

V. Phone/Fax

Practice location:
  • Phone: 949-998-0626
  • Fax:
Mailing address:
  • Phone: 949-998-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA RODRIGUEZ
Title or Position: MANAGER
Credential:
Phone: 949-998-0626