| Orange Valley Periodontal Care | |
|
6101 Ball Rd Ste 310 Cypress CA 90630-3966 | |
| (714) 220-9486 | |
| Not Available |
| Full Name | Orange Valley Periodontal Care |
|---|---|
| Speciality | Dentist |
| Location | 6101 Ball Rd Ste 310, Cypress, California |
| Authorized Official Name and Position | Lianne Swinehart (MANAGER) |
| Authorized Official Contact | 8665089491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orange Valley Periodontal Care 6101 Ball Rd Ste 310 Cypress CA 90630-3966 Ph: () - | Orange Valley Periodontal Care 6101 Ball Rd Ste 310 Cypress CA 90630-3966 Ph: (714) 220-9486 |
| NPI Number | 1346788981 |
|---|---|
| Provider Enumeration Date | 02/02/2017 |
| Last Update Date | 07/02/2019 |
| Medicare PECOS PAC ID | 0143656447 |
|---|---|
| Medicare Enrollment ID | O20200205001080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346788981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
| Provider Name | Alex A. Pezeshkian |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1538332028 PECOS PAC ID: 0941542021 Enrollment ID: I20200205001190 |
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