Healthcare Provider Details

I. General information

NPI: 1851091789
Provider Name (Legal Business Name): REDFORD FALLBROOK DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST STE 203
FALLBROOK CA
92028-3083
US

IV. Provider business mailing address

521 E ELDER ST STE 203
FALLBROOK CA
92028-3083
US

V. Phone/Fax

Practice location:
  • Phone: 760-280-6727
  • Fax:
Mailing address:
  • Phone: 760-280-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE A ROGERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-677-5113