# RODNEY D IDA DDS APC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922210665
- **Authorized official:** DR. RODNEY DEAN IDA DDS (PRESIDENT)
- **Authorized official phone:** (714) 547-8494

## Contact information

- **Practice address:** 17542 IRVINE BLVD STE A, TUSTIN, CA 92780-3155
- **Practice address phone:** (714) 547-8494
- **Practice address fax:** (714) 547-3448
- **Mailing address:** 17542 IRVINE BLVD, SUITE A, TUSTIN, CA 92780-3155
- **Mailing address phone:** (714) 547-8494
- **Mailing address fax:** (714) 547-3448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 36250 | CA | — |
| 1223E0200X | Endodontics | CA36250 | CA | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 11/08/2017