Provider Demographics
NPI:1467698829
Name:SAMONTE-MORA, MARY GRACE BARTOLOME (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARY GRACE
Middle Name:BARTOLOME
Last Name:SAMONTE-MORA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MARY GRACE
Other - Middle Name:BAROLOME
Other - Last Name:SAMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:16100 SAND CANYON AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3716
Mailing Address - Country:US
Mailing Address - Phone:949-727-9077
Mailing Address - Fax:949-727-9094
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-727-9077
Practice Address - Fax:949-727-9094
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice