Healthcare Provider Details

I. General information

NPI: 1326184169
Provider Name (Legal Business Name): DAVID R PLOCKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25460 MEDICAL CENTER DR SUITE 201
MURRIETA CA
92562-5985
US

IV. Provider business mailing address

113 MORRO HILLS RD
FALLBROOK CA
92028-9202
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4681
  • Fax:
Mailing address:
  • Phone: 760-728-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number32649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: