Healthcare Provider Details

I. General information

NPI: 1861882086
Provider Name (Legal Business Name): S TCHON & DA SMITH DDS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CEDAR RD STE B
VISTA CA
92083-5103
US

IV. Provider business mailing address

145 CEDAR RD STE B
VISTA CA
92083-5103
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-8891
  • Fax: 760-724-7950
Mailing address:
  • Phone: 760-724-8891
  • Fax: 760-724-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number63419
License Number StateCA

VIII. Authorized Official

Name: DAVID ALLAN SMITH
Title or Position: CFO
Credential: DDS, MD
Phone: 760-724-8891