Provider Demographics
NPI:1790959211
Name:DUONG AND PETCHPUD GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:DUONG AND PETCHPUD GENERAL PARTNERSHIP
Other - Org Name:SOUTH COAST DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BAOCHAU
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-360-1021
Mailing Address - Street 1:5 JOURNEY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5336
Mailing Address - Country:US
Mailing Address - Phone:949-360-1021
Mailing Address - Fax:949-360-4125
Practice Address - Street 1:5 JOURNEY
Practice Address - Street 2:SUITE 250
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5336
Practice Address - Country:US
Practice Address - Phone:949-360-1021
Practice Address - Fax:949-360-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty