=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164655858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREST FRANGOPOL, A DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2009
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26111 ANTONIO PKWY SUITE 200
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-5596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-713-6720
-----------------------------------------------------
Fax | 949-713-6721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 62 CORPORATE PARK SUITE 210
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-261-7500
-----------------------------------------------------
Fax | 949-261-7502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORP SEC/OFC MGR
-----------------------------------------------------
Name | CYMBREE ANNE CARACENA
-----------------------------------------------------
Credential | BSBA
-----------------------------------------------------
Telephone | 949-713-6720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 49519
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------