1891790390 NPI number — J.D. DE LORME, D.D.S., INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891790390 NPI number — J.D. DE LORME, D.D.S., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.D. DE LORME, D.D.S., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH OC PEDIATRIC DENTISTRY & ORTHODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891790390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26302 LA PAZ RD
Provider Second Line Business Mailing Address:
STE 114
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-5327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-581-5800
Provider Business Mailing Address Fax Number:
949-581-6794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26302 LA PAZ RD
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-581-5800
Provider Business Practice Location Address Fax Number:
949-581-6794
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DE LORME
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DENNIS
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
949-581-5800

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  O-118872-L , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B2321401 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D23214 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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