Provider Demographics
NPI:1194508184
Name:MD DENTAL CORP
Entity type:Organization
Organization Name:MD DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-335-0514
Mailing Address - Street 1:27882 FORBES RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1267
Mailing Address - Country:US
Mailing Address - Phone:949-249-2995
Mailing Address - Fax:
Practice Address - Street 1:27882 FORBES RD STE 204
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1267
Practice Address - Country:US
Practice Address - Phone:949-249-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental