Provider Demographics
NPI:1013408749
Name:CHRISTOPHER AUYONG, DDS, INC.
Entity Type:Organization
Organization Name:CHRISTOPHER AUYONG, DDS, INC.
Other - Org Name:SMILE MODERNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:AUYONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-554-1563
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7373
Mailing Address - Country:US
Mailing Address - Phone:949-554-1563
Mailing Address - Fax:949-554-1565
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7373
Practice Address - Country:US
Practice Address - Phone:949-554-1563
Practice Address - Fax:949-554-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63831261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental