Healthcare Provider Details

I. General information

NPI: 1942769898
Provider Name (Legal Business Name): PIERCE AESTHETICS DENTAL GROUP OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2492 WALNUT AVE STE 250
TUSTIN CA
92780-6963
US

IV. Provider business mailing address

2492 WALNUT AVE STE 250
TUSTIN CA
92780-6963
US

V. Phone/Fax

Practice location:
  • Phone: 949-350-0654
  • Fax:
Mailing address:
  • Phone: 949-379-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN PIERCE
Title or Position: OWNER DR
Credential: DDS
Phone: 949-379-6607