Healthcare Provider Details

I. General information

NPI: 1275068108
Provider Name (Legal Business Name): DAOUD AND EISSA DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E VISTA WAY STE A
VISTA CA
92084-4607
US

IV. Provider business mailing address

1010 E VISTA WAY STE A
VISTA CA
92084-4607
US

V. Phone/Fax

Practice location:
  • Phone: 760-659-6118
  • Fax: 760-659-6431
Mailing address:
  • Phone: 760-659-6118
  • Fax: 760-659-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59237
License Number StateCA

VIII. Authorized Official

Name: DR. KHALED EISSA
Title or Position: OFFICER
Credential: BDS
Phone: 763-587-8345