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Organization
COSTA MESA ORAL SURGERY
Active
Organization
COSTA MESA ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE DUONG PHAM DDS, MD (OWNER, PARTNER)
(310) 849-4690
Entity
Organization
Contact information
Practice address
2900 BRISTOL ST STE D101, COSTA MESA, CA 92626-5939
(562) 598-4683
Mailing address
4582 KATELLA AVE, LOS ALAMITOS, CA 90720-2655
(310) 849-4690
(562) 598-4693
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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