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General NPI Number Information
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NPI Number | 1689499204
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Entity Type | Organization
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Legal Business Name | SHELLAINE A DEL CAMPO AD SEDATION & IMPLANT DENTISTRY
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 113 WATERWORKS WAY STE 220
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City | IRVINE
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State | CA
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Zip | 92618-3176
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Country | US
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Telephone | 949-418-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WATERWORKS WAY STE 220
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City | IRVINE
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State | CA
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Zip | 92618-3176
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Country | US
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Telephone | 949-418-7339
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | SHELLAINE ALONSAGAY-DEL CAMPO
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Credential | DMD
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Telephone | 949-418-7339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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