Provider Demographics
NPI:1518995109
Name:CHILDREN'S DENTAL SURGERY CENTER, INC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-432-7337
Mailing Address - Street 1:1610 W EDINGER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4339
Mailing Address - Country:US
Mailing Address - Phone:714-432-7337
Mailing Address - Fax:714-432-7050
Practice Address - Street 1:1610 W EDINGER AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4339
Practice Address - Country:US
Practice Address - Phone:714-432-7337
Practice Address - Fax:714-432-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical