Healthcare Provider Details

I. General information

NPI: 1457414674
Provider Name (Legal Business Name): RAUL ENRIQUE ESCALANTE D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 NORDAHL RD SUITE 260
SAN MARCOS CA
92069-3595
US

IV. Provider business mailing address

838 NORDAHL RD SUITE 260
SAN MARCOS CA
92069-3595
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-1161
  • Fax: 760-743-3367
Mailing address:
  • Phone: 760-743-1161
  • Fax: 760-743-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: