Provider Demographics
NPI:1629356456
Name:CYPRESS GROVE DENTAL GROUP
Entity Type:Organization
Organization Name:CYPRESS GROVE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-891-0600
Mailing Address - Street 1:11939 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1238
Mailing Address - Country:US
Mailing Address - Phone:714-891-0600
Mailing Address - Fax:714-898-3705
Practice Address - Street 1:11939 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1238
Practice Address - Country:US
Practice Address - Phone:714-891-0600
Practice Address - Fax:714-898-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37165261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental