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General NPI Number Information
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NPI Number | 1932576220
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Entity Type | Organization
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Legal Business Name | DENTAL DIGITAL DESIGN
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 17781 SKY PARK CIR # D
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City | IRVINE
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State | CA
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Zip | 92614-6103
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Country | US
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Telephone | 949-252-0800
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Fax | 949-252-0801
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Provider Business Mailing Address
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Address Line | 17781 SKY PARK CIR # D
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City | IRVINE
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State | CA
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Zip | 92614-6103
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Country | US
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Telephone | 949-252-0800
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Fax | 949-252-0801
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. TAKANORI TANI
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Credential |
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Telephone | 949-252-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | 102325434
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License Number State | CA
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