Healthcare Provider Details

I. General information

NPI: 1578747754
Provider Name (Legal Business Name): EAST COUNTY ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2007
Last Update Date: 12/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S MAGNOLIA AVE
EL CAJON CA
92020-6011
US

IV. Provider business mailing address

506 S MAGNOLIA AVE
EL CAJON CA
92020-6011
US

V. Phone/Fax

Practice location:
  • Phone: 619-579-0316
  • Fax:
Mailing address:
  • Phone: 619-579-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number49302
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL DO
Title or Position: OWNER
Credential: D.D.S.
Phone: 619-579-0316