Organization
FAIR OAKS ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON BRADLEY (INSURANCE COORDINATOR)
(626) 795-5978
Entity
Organization
Contact information
Practice address
1318 FAIR OAKS AVE, SUITE A, SOUTH PASADENA, CA 91030-3808
(626) 795-5978
(626) 796-1173
Mailing address
1318 FAIR OAKS AVE, SUITE A, SOUTH PASADENA, CA 91030-3808
(626) 795-5978
(626) 796-1173
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
55726
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
58043
CA
Other
Enumeration date
02/07/2017
Last updated
02/07/2017
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