Healthcare Provider Details

I. General information

NPI: 1497810790
Provider Name (Legal Business Name): ESCONDIDO ENDODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 EAST VALLEY PARKWAY SUITE 307
ESCONDIDO CA
92025-3373
US

IV. Provider business mailing address

488 EAST VALLEY PARKWAY SUITE 307
ESCONDIDO CA
92025-3373
US

V. Phone/Fax

Practice location:
  • Phone: 760-739-1400
  • Fax: 760-739-1100
Mailing address:
  • Phone: 760-739-1400
  • Fax: 760-739-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number37237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number43444
License Number StateCA

VIII. Authorized Official

Name: ROBERT JOSEPH HANLON JR.
Title or Position: PRESIDENT
Credential: DMD
Phone: 760-739-1400