Healthcare Provider Details

I. General information

NPI: 1699320762
Provider Name (Legal Business Name): MICHAEL MURASKO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 S MELROSE DR
VISTA CA
92081-8788
US

IV. Provider business mailing address

2351 S MELROSE DR
VISTA CA
92081-8788
US

V. Phone/Fax

Practice location:
  • Phone: 760-598-8881
  • Fax: 760-598-8271
Mailing address:
  • Phone: 760-598-8881
  • Fax: 760-598-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL MURASKO
Title or Position: PRESIDENT
Credential:
Phone: 760-212-0103