Periodontics, Oral and Facial Surgical Specialties

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

PERIODONTICS, ORAL AND FACIAL SURGICAL SPECIALTIES

Doing business as

Orange County Oral Surgery and Periodontics

Practice address

29829 Santa Margarita Pkwy Ste 300
Rancho Santa Margarita, CA 92688-3623

Phone

(949) 888-0332

Fax

(949) 888-0400

NPI assigned

Jan 25, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Reza Bolourian, MDNPI 1336297365

Title

Owner

Phone

(949) 888-0332

Specialties & licenses 4

Addresses

Other names 1

• Orange County Oral Surgery and Periodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Reza Bolourian, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Powell, OH
  • NPI 1336297365
  NPD Authorized official

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1386234284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29829 SANTA MARGARITA PKWY STE 300",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926883623",
            "telephone_number": "949-888-0332",
            "fax_number": "949-888-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29829 SANTA MARGARITA PKWY STE 300",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926883623",
            "telephone_number": "949-888-0332",
            "fax_number": "949-888-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS, ORAL AND FACIAL SURGICAL SPECIALTIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "BOLOURIAN",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-888-0332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orange County Oral Surgery and Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bonnie Sue Payne
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• Devallee Pedrogo, PTA
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• Jenyffer Peterson
• Camtu Pham, D.D.S.
• Lillian Man Phan, DPT
• Physician Assistant Specialists-California Inc
• Pierson Family Chiropractic

• Oral and Maxillofacial Surgery (Dentist) in Rancho Santa Margarita, CA
• Providers in Rancho Santa Margarita, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.