Organization
SUSAN A BOLLINGER DDS
Active
Other names
Bayshore Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY MARIE KENNON (OFFICE MANAGER)
(949) 759-7007
Entity
Organization
Contact information
Practice address
1401 AVOCADO AVE STE 309, NEWPORT BEACH, CA 92660-8733
(949) 759-7007
Mailing address
1401 AVOCADO AVE STE 309, NEWPORT BEACH, CA 92660-8733
(949) 759-7007
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
26589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7560010001
PTAN
CA
Enumeration date
11/14/2016
Last updated
11/14/2016
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