Provider Demographics
NPI:1366572679
Name:NEWPORT ENDODONTIC GROUP
Entity type:Organization
Organization Name:NEWPORT ENDODONTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONCRISTIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-644-0595
Mailing Address - Street 1:1441 AVOCADO AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7705
Mailing Address - Country:US
Mailing Address - Phone:949-644-0595
Mailing Address - Fax:949-644-5082
Practice Address - Street 1:1441 AVOCADO AVE STE 401
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7705
Practice Address - Country:US
Practice Address - Phone:949-644-0595
Practice Address - Fax:949-644-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty