Organization
PETER SUMARSONO PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ROBERTSON SUMARSONO DDS (DENTIST)
(714) 864-8261
Entity
Organization
Contact information
Practice address
9110 ADAMS AVENUE, HUNTINGTON BEACH, CA 92646
(714) 968-4487
(714) 968-1146
Mailing address
18543 YORBA LINDA BLVD. #250, YORBA LINDA, CA 92886
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
40736
CA
Other
Enumeration date
05/01/2015
Last updated
05/01/2015
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