| Coastal Dental Group | |
|
2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 | |
| (949) 515-9280 | |
| (949) 515-9289 |
| Full Name | Coastal Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 2263 Fairview Rd Ste K, Costa Mesa, California |
| Authorized Official Name and Position | Derek Dungquang Duong (PRESIDENT) |
| Authorized Official Contact | 9495159280 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Dental Group 2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 Ph: (949) 515-9280 | Coastal Dental Group 2263 Fairview Rd Ste K Costa Mesa CA 92627-1672 Ph: (949) 515-9280 |
| NPI Number | 1144370768 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 12/29/2017 |
| Medicare PECOS PAC ID | 7012277908 |
|---|---|
| Medicare Enrollment ID | O20180423002568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144370768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 48906 (California) | Primary |
| Provider Name | Derek D Duong |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1922127703 PECOS PAC ID: 4486914371 Enrollment ID: I20180423002911 |
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