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General NPI Number Information
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NPI Number | 1619168010
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Entity Type | Organization
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Legal Business Name | TONY DO DDS INC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 1132 N BROOKHURST ST STE B
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City | ANAHEIM
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State | CA
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Zip | 92801-1791
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Country | US
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Telephone | 714-535-0535
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Fax | 714-535-0090
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Provider Business Mailing Address
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Address Line | 1132 N BROOKHURST ST STE B
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City | ANAHEIM
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State | CA
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Zip | 92801-1791
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Country | US
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Telephone | 714-535-0535
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Fax | 714-535-0090
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONY D DO
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Credential | DDS
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Telephone | 949-439-4389
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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 | 48801
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License Number State | CA
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