Healthcare Provider Details

I. General information

NPI: 1598819120
Provider Name (Legal Business Name): MITCHELL POISET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 FROST ST SUITE 101
SAN DIEGO CA
92123-2737
US

IV. Provider business mailing address

7930 FROST ST SUITE 101
SAN DIEGO CA
92123-2737
US

V. Phone/Fax

Practice location:
  • Phone: 858-492-9977
  • Fax: 858-492-9910
Mailing address:
  • Phone: 858-492-9977
  • Fax: 858-492-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberB32650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: