NPI 1033596788

Peter Sumarsono Professional Dental Corporation

Organisation Preferred Provider Organization Huntington Beach, CA

Practice location

Address: 9110 Adams Avenue, Huntington Beach, CA 92646
Phone: (714) 968-4487
Fax: (714) 968-1146
Mailing address: 18543 Yorba Linda Blvd. #250, Yorba Linda, CA 92886

Authorised official

Name: Peter Robertson Sumarsono
Title: Dentist
Phone: (714) 864-8261

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 40736 (CA)

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Registry record

NPI: 1033596788
Entity type: Organization
NPI issued: 1 May 2015
Record last updated: 1 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.