Provider Demographics
NPI:1225747801
Name:ALMODOVAR DENTISTRY, INC.
Entity Type:Organization
Organization Name:ALMODOVAR DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ALMODOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-614-2854
Mailing Address - Street 1:9161 GUSS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4604
Mailing Address - Country:US
Mailing Address - Phone:714-614-2854
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR STE 200
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1546
Practice Address - Country:US
Practice Address - Phone:714-546-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental