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Organization
PERIODONTICS, ORAL AND FACIAL SURGICAL SPECIALTIES
Active
Organization
PERIODONTICS, ORAL AND FACIAL SURGICAL SPECIALTIES
Active
Other names
Orange County Oral Surgery and Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REZA BOLOURIAN MD (OWNER)
(949) 888-0332
Entity
Organization
Contact information
Practice address
29829 SANTA MARGARITA PKWY STE 300, RANCHO SANTA MARGARITA, CA 92688-3623
(949) 888-0332
(949) 888-0400
Mailing address
29829 SANTA MARGARITA PKWY STE 300, RANCHO SANTA MARGARITA, CA 92688-3623
(949) 888-0332
(949) 888-0400
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
NULL
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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