Provider Demographics
NPI:1407961725
Name:DONALD ALLEN GRUPE DDS INC
Entity Type:Organization
Organization Name:DONALD ALLEN GRUPE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GRUPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-752-7555
Mailing Address - Street 1:2192 MARTIN
Mailing Address - Street 2:#240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612
Mailing Address - Country:US
Mailing Address - Phone:949-752-7555
Mailing Address - Fax:949-752-1384
Practice Address - Street 1:2192 MARTIN AVE
Practice Address - Street 2:#240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612
Practice Address - Country:US
Practice Address - Phone:949-752-7555
Practice Address - Fax:949-752-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty