Provider Demographics
NPI:1861888190
Name:MUIRLANDS DENTAL
Entity type:Organization
Organization Name:MUIRLANDS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-458-1012
Mailing Address - Street 1:23361 EL TORO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4810
Mailing Address - Country:US
Mailing Address - Phone:949-458-1012
Mailing Address - Fax:949-458-1013
Practice Address - Street 1:23361 EL TORO RD STE#105
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-458-1012
Practice Address - Fax:949-458-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental