Provider Demographics
NPI:1700206737
Name:OC DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:OC DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-606-9194
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-1600
Mailing Address - Country:US
Mailing Address - Phone:714-606-9194
Mailing Address - Fax:
Practice Address - Street 1:435 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2917
Practice Address - Country:US
Practice Address - Phone:714-635-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty