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General NPI Number Information
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NPI Number | 1376990382
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Entity Type | Organization
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Legal Business Name | SUSAN A. BOLLINGER, DDS, INC.
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 1401 AVOCADO AVE SUITE 309
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7720
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Country | US
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Telephone | 949-759-7007
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Fax | 949-644-0446
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Provider Business Mailing Address
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Address Line | 1401 AVOCADO AVE SUITE 309
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7720
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Country | US
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Telephone | 949-759-7007
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Fax | 949-644-0446
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SUSAN ADELE BOLLINGER
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Credential | DDS
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Telephone | 949-759-7007
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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 | 26589
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License Number State | CA
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