Individual
CASEY VIDOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30575 TRABUCO CANYON RD, SUITE 106, TRABUCO CANYON, CA 92679-3034
(949) 858-5147
Mailing address
30575 TRABUCO CANYON RD, SUITE 106, TRABUCO CANYON, CA 92679-3034
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
63592
CA
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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