Provider Demographics
NPI:1629451851
Name:DENTAL GROUP OF ORANGE COUNTY
Entity Type:Organization
Organization Name:DENTAL GROUP OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-855-1138
Mailing Address - Street 1:9535 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1550
Mailing Address - Country:US
Mailing Address - Phone:714-855-1138
Mailing Address - Fax:951-848-0755
Practice Address - Street 1:9535 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1550
Practice Address - Country:US
Practice Address - Phone:714-855-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty