Healthcare Provider Details

I. General information

NPI: 1407237332
Provider Name (Legal Business Name): DAOUD DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 BALBOA AVE SUITE A-2
SAN DIEGO CA
92117-6958
US

IV. Provider business mailing address

5210 BALBOA AVE SUITE A-2
SAN DIEGO CA
92117-6958
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-5842
  • Fax:
Mailing address:
  • Phone: 858-598-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number59297
License Number StateCA

VIII. Authorized Official

Name: HASAN DAOUD
Title or Position: DENTIST
Credential: D.D.S
Phone: 858-598-5842