Provider Demographics
NPI:1457711699
Name:SURGER DENTAL CORPORATION
Entity Type:Organization
Organization Name:SURGER DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-640-0501
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:507
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-640-0501
Mailing Address - Fax:949-640-0826
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:507
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-640-0501
Practice Address - Fax:949-640-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty