Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 41172 | CA |
NPI | 1003943580 |
---|---|
Provider Name | Dr. John Dennis De Lorme |
First Address | Mission Viejo, CA 92691-5313 |
Second Address | Mission Viejo, CA 92691-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |