Healthcare Provider Details

I. General information

NPI: 1679769731
Provider Name (Legal Business Name): JOHN P. DUCAR, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD SUITE 450
TORRANCE CA
90503-4504
US

IV. Provider business mailing address

4201 TORRANCE BLVD SUITE 450
TORRANCE CA
90503-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-1415
  • Fax: 310-540-1423
Mailing address:
  • Phone: 310-540-1415
  • Fax: 310-540-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number35488
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN P DUCAR
Title or Position: OWNER
Credential: DDS
Phone: 310-540-1415