Provider Demographics
NPI:1255393096
Name:ONTIVEROS, ARTHUR ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:ALLEN
Last Name:ONTIVEROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 11-C
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-643-2803
Mailing Address - Fax:949-643-2805
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 11-C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-643-2803
Practice Address - Fax:949-643-2805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice