Provider Demographics
NPI:1104978295
Name:RESTREPO, CARLOS H (DDS)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:H
Last Name:RESTREPO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31920 DEL OBISPO ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3187
Mailing Address - Country:US
Mailing Address - Phone:949-276-2220
Mailing Address - Fax:949-276-2221
Practice Address - Street 1:31920 DEL OBISPO ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3187
Practice Address - Country:US
Practice Address - Phone:949-276-2220
Practice Address - Fax:949-276-2221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice