| Titan Dental | |
|
391 S State College Blvd Suite M Brea CA 92821-5755 | |
| (714) 990-3321 | |
| (714) 990-3546 |
| Full Name | Titan Dental |
|---|---|
| Speciality | Dentist |
| Location | 391 S State College Blvd, Brea, California |
| Authorized Official Name and Position | Thuy Bich Le (OWNER) |
| Authorized Official Contact | 7149903321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Titan Dental 391 S State College Blvd Suite M Brea CA 92821-5755 Ph: (714) 990-3321 | Titan Dental 391 S State College Blvd Suite M Brea CA 92821-5755 Ph: (714) 990-3321 |
| NPI Number | 1609230523 |
|---|---|
| Provider Enumeration Date | 04/06/2016 |
| Last Update Date | 04/06/2016 |
| Medicare PECOS PAC ID | 0446538656 |
|---|---|
| Medicare Enrollment ID | O20190607002441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609230523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 49357 (California) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
| Provider Name | Thuy Bich Le |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1164507877 PECOS PAC ID: 1153609391 Enrollment ID: I20190610001080 |
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