Healthcare Provider Details

I. General information

NPI: 1750740080
Provider Name (Legal Business Name): ORANGE COUNTY OROFACIAL PAIN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE SUITE 402
PASADENA CA
91105-2561
US

IV. Provider business mailing address

301 S FAIR OAKS AVE SUITE 402
PASADENA CA
91105-2561
US

V. Phone/Fax

Practice location:
  • Phone: 626-658-9004
  • Fax: 626-658-9034
Mailing address:
  • Phone: 626-658-9004
  • Fax: 626-658-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KEVIN J CEBULA
Title or Position: DDS
Credential: DDS
Phone: 626-658-9004