Provider Demographics
NPI:1508204967
Name:HUSS DENTAL CORPORATION
Entity Type:Organization
Organization Name:HUSS DENTAL CORPORATION
Other - Org Name:PARK PLACE DENTAL GROUP AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEDEDIAH
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-499-4441
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:501 S REINO RD
Practice Address - Street 2:SUITE G
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4269
Practice Address - Country:US
Practice Address - Phone:805-499-4441
Practice Address - Fax:805-499-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty