Healthcare Provider Details

I. General information

NPI: 1265865570
Provider Name (Legal Business Name): CONSTANTINE NICOLAS REPPAS D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CIVIC CENTER DR STE 230
SAN MARCOS CA
92069-2925
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: