Healthcare Provider Details

I. General information

NPI: 1609846542
Provider Name (Legal Business Name): DAVID R. CUMMINGS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR SUITE 402
NEWPORT BEACH CA
92660-7853
US

IV. Provider business mailing address

360 SAN MIGUEL DR SUITE 402
NEWPORT BEACH CA
92660-7853
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-1600
  • Fax: 949-760-0911
Mailing address:
  • Phone: 949-760-1600
  • Fax: 949-760-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number33505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number39142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: