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General NPI Number Information
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NPI Number | 1053064691
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Entity Type | Organization
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Legal Business Name | MAGIC FOX ORTHODONTICS
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 17041 BEACH BLVD STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6097
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Country | US
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Telephone | 714-594-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 17041 BEACH BLVD STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6097
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Country | US
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Telephone | 714-594-5777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA MARIE VEN DANGE
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Credential | DMD
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Telephone | 714-206-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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