Healthcare Provider Details

I. General information

NPI: 1356400527
Provider Name (Legal Business Name): RUSSELL F M SOON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29645 RANCHO CALIFORNIA RD STE 114
TEMECULA CA
92591
US

IV. Provider business mailing address

29645 RANCHO CALIFORNIA RD STE 114
TEMECULA CA
92591
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-0196
  • Fax: 951-699-9275
Mailing address:
  • Phone: 951-676-0196
  • Fax: 951-699-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: