Provider Demographics
NPI:1891790390
Name:J.D. DE LORME, D.D.S., INC
Entity Type:Organization
Organization Name:J.D. DE LORME, D.D.S., INC
Other - Org Name:SOUTH OC PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:DE LORME
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-581-5800
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:STE 114
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5327
Mailing Address - Country:US
Mailing Address - Phone:949-581-5800
Mailing Address - Fax:949-581-6794
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:STE 114
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5327
Practice Address - Country:US
Practice Address - Phone:949-581-5800
Practice Address - Fax:949-581-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAO-118872-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2321401OtherDENTICAL
CAD23214Medicaid