Susan a. Bollinger, DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

26589 Issued in CA

Legal business name

SUSAN A. BOLLINGER, DDS, INC.

Practice address

1401 Avocado Ave
Suite 309
Newport Beach, CA 92660-7720

Phone

(949) 759-7007

Fax

(949) 644-0446

NPI assigned

May 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Adele Bollinger, DDS

Title

Owner/President

Phone

(949) 759-7007

Specialties & licenses 1

Addresses

Other names 1

• Bayshore Dental Group Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1376990382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "SUITE 309",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-759-7007",
            "fax_number": "949-644-0446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "SUITE 309",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-759-7007",
            "fax_number": "949-644-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN A. BOLLINGER, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2016-05-19",
        "status": "A",
        "authorized_official_last_name": "BOLLINGER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ADELE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "949-759-7007",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "26589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayshore Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.