Provider Demographics
NPI:1710908876
Name:GREGORY CLIBON, DDS - BEACH CITIES DENTAL GROUP, APC
Entity Type:Organization
Organization Name:GREGORY CLIBON, DDS - BEACH CITIES DENTAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CLIBON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-633-2635
Mailing Address - Street 1:25652 LA CIMA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4524
Mailing Address - Country:US
Mailing Address - Phone:949-633-2635
Mailing Address - Fax:949-429-5815
Practice Address - Street 1:675 CAMINO DE LOS MARES STE 304
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2837
Practice Address - Country:US
Practice Address - Phone:949-496-5001
Practice Address - Fax:949-496-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty