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NPI Code Detail

MEDICARE: MAXIMO DANIEL MEZA-CRESPO DDS

MEDICARE: MAXIMO DANIEL MEZA-CRESPO DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist42572CA

General Provider Information

NPI Number : 1275636870
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAXIMO DANIEL MEZA-CRESPO DDS
Provider Business Mailing Address
First Line : 1275 30TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-3476
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 3177 OCEAN VIEW BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-1432
Country : US
Telephone Number : 619-662-4100
Fax Number : 619-232-5922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 10/20/2015

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Directions to “ MAXIMO DANIEL MEZA-CRESPO DDS” Practice Location

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