Healthcare Provider Details

I. General information

NPI: 1215336078
Provider Name (Legal Business Name): OCEANVIEW DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S EL CAMINO REAL STE 101
OCEANSIDE CA
92054-6260
US

IV. Provider business mailing address

2125 S EL CAMINO REAL STE 101
OCEANSIDE CA
92054-6260
US

V. Phone/Fax

Practice location:
  • Phone: 760-433-0393
  • Fax:
Mailing address:
  • Phone: 760-433-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29288
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number32108
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60272
License Number StateCA

VIII. Authorized Official

Name: JAMES S HARGAS
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 760-433-0393