Provider Demographics
NPI:1124251996
Name:HOMECARE DENTISTS
Entity type:Organization
Organization Name:HOMECARE DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-429-7100
Mailing Address - Street 1:27126 PASEO ESPADA STE 705
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2721
Mailing Address - Country:US
Mailing Address - Phone:949-429-7100
Mailing Address - Fax:949-429-7101
Practice Address - Street 1:27126 PASEO ESPADA STE 705
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2721
Practice Address - Country:US
Practice Address - Phone:949-429-7100
Practice Address - Fax:949-429-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty