Healthcare Provider Details

I. General information

NPI: 1235132127
Provider Name (Legal Business Name): WILLIAM SIDNEY COMBS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 MIDLAND RD STE A
POWAY CA
92064-4746
US

IV. Provider business mailing address

PO BOX 623
POWAY CA
92074-0623
US

V. Phone/Fax

Practice location:
  • Phone: 858-748-2364
  • Fax:
Mailing address:
  • Phone: 858-748-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: