Provider Demographics
NPI:1679081848
Name:THAYER HUSSEIN DDS,INC
Entity Type:Organization
Organization Name:THAYER HUSSEIN DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-588-6500
Mailing Address - Street 1:10591 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2149
Mailing Address - Country:US
Mailing Address - Phone:714-588-6500
Mailing Address - Fax:
Practice Address - Street 1:13872 HARBOR BLVD STE 1A-3
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4041
Practice Address - Country:US
Practice Address - Phone:714-265-1000
Practice Address - Fax:714-265-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64043261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881030872Medicaid