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General NPI Number Information
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NPI Number | 1225747801
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Entity Type | Organization
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Legal Business Name | ALMODOVAR DENTISTRY, INC.
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1503 S COAST DR STE 200
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City | COSTA MESA
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State | CA
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Zip | 92626-1546
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Country | US
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Telephone | 714-546-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 9161 GUSS DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-4604
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Country | US
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Telephone | 714-614-2854
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DREW ANTHONY ALMODOVAR
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Credential | D.D.S.
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Telephone | 714-614-2854
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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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