Healthcare Provider Details

I. General information

NPI: 1548579527
Provider Name (Legal Business Name): OSCAR MACIAS RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44558 10TH ST W
LANCASTER CA
93534-3333
US

IV. Provider business mailing address

29684 KINGS CANYON PL
CANYON COUNTRY CA
91387-6242
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-1111
  • Fax:
Mailing address:
  • Phone: 661-317-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number17380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: