Provider Demographics
NPI:1689261935
Name:DAMON ANDERSON DDS, INC.
Entity Type:Organization
Organization Name:DAMON ANDERSON DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-643-3129
Mailing Address - Street 1:25500 RANCHO NIGUEL RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7306
Mailing Address - Country:US
Mailing Address - Phone:949-643-3129
Mailing Address - Fax:949-643-5259
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 260
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7306
Practice Address - Country:US
Practice Address - Phone:949-643-3129
Practice Address - Fax:949-643-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental