Healthcare Provider Details

I. General information

NPI: 1255790101
Provider Name (Legal Business Name): REPPAS & EL-MAASRI DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2016
Last Update Date: 02/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CIVIC CENTER DR SUITE 230
SAN MARCOS CA
92069-2918
US

IV. Provider business mailing address

1 CIVIC CENTER DR SUITE 230
SAN MARCOS CA
92069-2918
US

V. Phone/Fax

Practice location:
  • Phone: 760-798-4178
  • Fax: 760-798-0564
Mailing address:
  • Phone: 760-798-4178
  • Fax: 760-798-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62740
License Number StateCA

VIII. Authorized Official

Name: DR. JOANNA EL-MAASRI REPPAS
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 760-798-4178