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General NPI Number Information
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NPI Number | 1467775122
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Entity Type | Organization
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Legal Business Name | RICHARD L. BOTZBACH II DENTAL CORPORATION
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 6 B LIBERTY SUITE 220
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5835
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Country | US
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Telephone | 949-362-9971
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Fax | 949-362-9886
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Provider Business Mailing Address
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Address Line | 6 B LIBERTY SUITE 220
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5835
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Country | US
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Telephone | 949-362-9971
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Fax | 949-362-9886
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | RICHARD LLOYD BOTZBACH II
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Credential | D.D.S., M.S.
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Telephone | 949-362-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 39235
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License Number State | CA
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