Provider Demographics
NPI:1194070441
Name:EIDELSTEIN, NATALIE (DDS)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:EIDELSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25542 JERONIMO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2724
Mailing Address - Country:US
Mailing Address - Phone:949-457-0223
Mailing Address - Fax:
Practice Address - Street 1:25542 JERONIMO RD STE 3
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2724
Practice Address - Country:US
Practice Address - Phone:949-457-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60948122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist