Healthcare Provider Details

I. General information

NPI: 1386603827
Provider Name (Legal Business Name): PAUL HOWE VAN HORNE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 PARKWAY DR STE 115
LA MESA CA
91942-1534
US

IV. Provider business mailing address

7200 PARKWAY DR STE 115
LA MESA CA
91942-1534
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-5883
  • Fax: 619-463-5888
Mailing address:
  • Phone: 619-463-5883
  • Fax: 619-463-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34007
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901013842
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: