Healthcare Provider Details

I. General information

NPI: 1396948527
Provider Name (Legal Business Name): JAMES ROBERT MEBUST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4367 30TH ST
SAN DIEGO CA
92104-1313
US

IV. Provider business mailing address

4367 30TH ST
SAN DIEGO CA
92104-1313
US

V. Phone/Fax

Practice location:
  • Phone: 619-283-3383
  • Fax: 619-283-0530
Mailing address:
  • Phone: 619-283-3383
  • Fax: 619-283-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: