=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942303821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUEHLER DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31796 COAST HWY
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-6974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-419-1020
-----------------------------------------------------
Fax | 949-415-1030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2860 MICHELLE 2ND FLOOR
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-508-3600
-----------------------------------------------------
Fax | 714-368-2092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DOCTOR
-----------------------------------------------------
Name | DR. BRIAN D BUEHLER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 949-415-1020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 31866
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------