Provider Demographics
NPI:1174645410
Name:EXCEL DENTAL GROUP
Entity Type:Organization
Organization Name:EXCEL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-525-5558
Mailing Address - Street 1:1602 N LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-525-5558
Mailing Address - Fax:714-525-8288
Practice Address - Street 1:1602 N LEMON ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-525-5558
Practice Address - Fax:714-525-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9313501OtherDENTICAL