Healthcare Provider Details

I. General information

NPI: 1720158629
Provider Name (Legal Business Name): BRYAN P RASMUSSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BASILONE ROAD, AREA 52, BLDG 520448
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

BASILONE ROAD, AREA 52, BLDG 520448
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-9655
  • Fax:
Mailing address:
  • Phone: 760-763-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number51849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: