Provider Demographics
NPI:1730484320
Name:GOUVION AND GRANT DENTISTRY
Entity Type:Organization
Organization Name:GOUVION AND GRANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOUVION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-733-1860
Mailing Address - Street 1:18124 CULVER DR STE H
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2729
Mailing Address - Country:US
Mailing Address - Phone:949-733-1860
Mailing Address - Fax:949-733-3156
Practice Address - Street 1:18124 CULVER DR STE H
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2729
Practice Address - Country:US
Practice Address - Phone:949-733-1860
Practice Address - Fax:949-733-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193461223G0001X
CA510701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty