Individual
BERTHA AMERICA FAVELA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
30814 COAST HWY, LAGUNA BEACH, CA 92651-8136
(949) 499-1200
Mailing address
26895 ALISO CREEK RD, ALISO VIEJO, CA 92656-5301
(949) 499-1200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
42310
CA
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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