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General NPI Number Information
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NPI Number | 1811098213
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Entity Type | Organization
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Legal Business Name | ALISO WOODS DENTAL
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27792 ALISO CREEK RD B-170
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3833
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Country | US
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Telephone | 949-360-1213
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Fax | 949-360-7266
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Provider Business Mailing Address
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Address Line | 27792 ALISO CREEK RD B-170
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3833
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Country | US
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Telephone | 949-360-1213
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Fax | 949-360-7266
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CARLY GAIL BRUNDAGE
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Credential |
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Telephone | 949-360-1213
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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 |
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License Number State |
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