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General NPI Number Information
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NPI Number | 1790959211
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Entity Type | Organization
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Legal Business Name | DUONG AND PETCHPUD GENERAL PARTNERSHIP
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 5 JOURNEY SUITE 250
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5336
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Country | US
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Telephone | 949-360-1021
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Fax | 949-360-4125
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Provider Business Mailing Address
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Address Line | 5 JOURNEY SUITE 250
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5336
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Country | US
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Telephone | 949-360-1021
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Fax | 949-360-4125
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Authorized Official
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Title or Position | OWNER PARTNER
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Name | BAOCHAU T DUONG
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Credential | DDS
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Telephone | 949-360-1021
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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 | 55112
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License Number State | CA
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