Provider Demographics
NPI:1902013683
Name:NEWPORT CENTER DENTAL GROUP
Entity Type:Organization
Organization Name:NEWPORT CENTER DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-640-1122
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-640-1122
Mailing Address - Fax:949-640-0929
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-640-1122
Practice Address - Fax:949-640-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty