1891717591 NPI number — GREGORY CLIBON, DDS APC HERITAGE FAMILY DENTAL

Table of content: (NPI 1891717591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891717591 NPI number — GREGORY CLIBON, DDS APC HERITAGE FAMILY DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY CLIBON, DDS APC HERITAGE FAMILY DENTAL
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:
Provider Other Organization Name Type Code:
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:
1891717591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25652 LA CIMA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA NIGUEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92677-4524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-633-2635
Provider Business Mailing Address Fax Number:
949-429-5815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14150 CULVER DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-0323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-552-4226
Provider Business Practice Location Address Fax Number:
949-552-0265
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLIBON
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-633-2635

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  44580 , 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)





Copyright © 2007-2025 www.npivalidator.com