Provider Demographics
NPI:1780721050
Name:LIVIU GOLD D.D.S., INC.
Entity type:Organization
Organization Name:LIVIU GOLD D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LANNDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-650-6772
Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-650-6772
Mailing Address - Fax:949-645-5701
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-650-6772
Practice Address - Fax:949-645-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty