Healthcare Provider Details

I. General information

NPI: 1992284301
Provider Name (Legal Business Name): LAO ABICHAKER BURNS DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2371 S MELROSE DR
VISTA CA
92081-8788
US

IV. Provider business mailing address

14618 CARMEL RIDGE RD
SAN DIEGO CA
92128-3738
US

V. Phone/Fax

Practice location:
  • Phone: 619-200-8300
  • Fax:
Mailing address:
  • Phone: 619-200-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number59010
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number59203
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTAIN LIN-BURNS
Title or Position: PARTNER
Credential: DDS
Phone: 619-200-8300