Healthcare Provider Details

I. General information

NPI: 1013086032
Provider Name (Legal Business Name): WAYNE MICHAEL DEUTSCH DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 CRAVEN ST
SAN DIEGO CA
92136-5596
US

IV. Provider business mailing address

2310 CRAVEN ST
SAN DIEGO CA
92136-5596
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8210
  • Fax:
Mailing address:
  • Phone: 619-556-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD9110
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5474
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: