| M Roberta Dornan Dds Inc | |
|
13422 Newport Ave Ste B Tustin CA 92780-3746 | |
| (714) 544-2020 | |
| (714) 544-7620 |
| Full Name | M Roberta Dornan Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 13422 Newport Ave Ste B, Tustin, California |
| Authorized Official Name and Position | Maureen Roberta Dornan (OWNER) |
| Authorized Official Contact | 7145442020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M Roberta Dornan Dds Inc 13422 Newport Ave Ste B Tustin CA 92780-3746 Ph: (714) 544-2020 | M Roberta Dornan Dds Inc 13422 Newport Ave Ste B Tustin CA 92780-3746 Ph: (714) 544-2020 |
| NPI Number | 1023370426 |
|---|---|
| Provider Enumeration Date | 06/12/2012 |
| Last Update Date | 02/08/2018 |
| Medicare PECOS PAC ID | 6204087984 |
|---|---|
| Medicare Enrollment ID | O20121105000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023370426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30107 (California) | Primary |
| Provider Name | Maureen R Dornan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1477559896 PECOS PAC ID: 0648421321 Enrollment ID: I20121105000637 |
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