Healthcare Provider Details

I. General information

NPI: 1508778010
Provider Name (Legal Business Name): PAUL MIRDAMADI ORAL SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ENCINITAS BLVD STE 118
ENCINITAS CA
92024-3781
US

IV. Provider business mailing address

1647 MILAN WAY
SAN MARCOS CA
92078-1085
US

V. Phone/Fax

Practice location:
  • Phone: 213-259-4867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: PAUL MIRDAMADI
Title or Position: CEO/SURGEON
Credential: DDS,MS
Phone: 213-259-4867