Healthcare Provider Details

I. General information

NPI: 1831254671
Provider Name (Legal Business Name): SONNY ESLAMPOUR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S RANCHO SANTA FE RD SUITE 100
SAN MARCOS CA
92078-3698
US

IV. Provider business mailing address

555 S RANCHO SANTA FE RD SUITE 100
SAN MARCOS CA
92078-3698
US

V. Phone/Fax

Practice location:
  • Phone: 760-510-9009
  • Fax: 760-510-8008
Mailing address:
  • Phone: 760-510-9009
  • Fax: 760-510-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: