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General NPI Number Information
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NPI Number | 1316140213
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Entity Type | Organization
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Legal Business Name | ESTAVILLO DENTAL CORPORATION
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 39885 ALTA MURRIETA DR SUITE D-4
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City | MURRIETA
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State | CA
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Zip | 92563-5438
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Country | US
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Telephone | 951-304-7560
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Fax | 951-696-7780
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Provider Business Mailing Address
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Address Line | 39885 ALTA MURRIETA DR SUITE D-4
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City | MURRIETA
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State | CA
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Zip | 92563-5438
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Country | US
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Telephone | 951-304-7560
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Fax | 951-696-7780
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Authorized Official
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Title or Position | OWNER
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Name | DR. NGOC-OANH NGO ESTAVILLO
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Credential | D.D.S.
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Telephone | 951-304-7560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 47966
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License Number State | CA
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