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General NPI Number Information
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NPI Number | 1073255626
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Entity Type | Organization
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Legal Business Name | MOLLER&IRENEDMD, INC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 9092 TALBERT AVE STE 12
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4475
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Country | US
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Telephone | 714-963-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 1747 GRAND AVE UNIT 4
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City | LONG BEACH
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State | CA
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Zip | 90804-2065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MOLLER AWAD
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Credential |
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Telephone | 949-689-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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