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General NPI Number Information
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NPI Number | 1447463146
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Entity Type | Organization
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Legal Business Name | COASTLINE DENTAL CARE
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 16033 BOLSA CHICA ST # 110
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2452
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Country | US
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Telephone | 714-846-7700
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Fax | 714-846-7707
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Provider Business Mailing Address
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Address Line | 16033 BOLSA CHICA ST # 110
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2452
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Country | US
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Telephone | 714-846-7700
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Fax | 714-846-7707
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL CUONG DONG
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Credential | DMD
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Telephone | 714-846-7700
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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 | 49746
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License Number State | CA
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