| Tustin Avenue Dental Team | |
|
1100 N Tustin Ave Suite C Santa Ana CA 92705-3509 | |
| (714) 543-9762 | |
| (714) 973-0939 |
| Full Name | Tustin Avenue Dental Team |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 N Tustin Ave, Santa Ana, California |
| Authorized Official Name and Position | Christine P Oh (PRESIDENT) |
| Authorized Official Contact | 7145439762 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tustin Avenue Dental Team 1100 N Tustin Ave Suite C Santa Ana CA 92705-3509 Ph: (714) 543-9762 | Tustin Avenue Dental Team 1100 N Tustin Ave Suite C Santa Ana CA 92705-3509 Ph: (714) 543-9762 |
| NPI Number | 1265973275 |
|---|---|
| Provider Enumeration Date | 03/10/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 6608208756 |
|---|---|
| Medicare Enrollment ID | O20191112001508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265973275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 34642 (California) | Primary |
| Provider Name | Christine P Oh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053452367 PECOS PAC ID: 9234442484 Enrollment ID: I20191112001702 |
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