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General NPI Number Information
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NPI Number | 1619243094
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Entity Type | Organization
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Legal Business Name | HARBOUR DENTAL
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 5219 WARNER AVENUE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-846-0000
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Fax | 714-846-0088
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Provider Business Mailing Address
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Address Line | 5219 WARNER AVENUE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-846-0000
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Fax | 714-846-0088
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY NGO
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Credential | D.M.D.
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Telephone | 702-580-1273
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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 | 45936
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45936
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License Number State | CA
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