Organization
SCHUPPET DENTAL CORPORATION
Active
Other names
Elite Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY C SCHUPPERT D.D.S., M.S. (PRESIDENT)
(949) 863-9620
Entity
Organization
Contact information
Practice address
12791 NEWPORT AVE STE 208, TUSTIN, CA 92780-8023
(714) 544-1740
Mailing address
20062 SW BIRCH ST STE 220, NEWPORT BEACH, CA 92660-1519
(949) 863-9620
(949) 271-4931
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
54324
CA
Other
Enumeration date
03/30/2010
Last updated
03/30/2010
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