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General NPI Number Information
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NPI Number | 1124251996
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Entity Type | Organization
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Legal Business Name | HOMECARE DENTISTS
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 27126 PASEO ESPADA STE 705
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2721
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Country | US
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Telephone | 949-429-7100
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Fax | 949-429-7101
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Provider Business Mailing Address
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Address Line | 27126 PASEO ESPADA STE 705
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2721
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Country | US
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Telephone | 949-429-7100
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Fax | 949-429-7101
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Authorized Official
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Title or Position | DENTIST
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Name | KEVIN WARTHAN
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Credential | DDS
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Telephone | 949-429-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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