=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053653527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL CARE MANAGEMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2013
-----------------------------------------------------
Last Update Date | 03/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3211 BUSINESS PARK DR STE A
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92081-8259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-727-6800
-----------------------------------------------------
Fax | 760-727-4225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1477 SAN PABLO DR
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-727-6800
-----------------------------------------------------
Fax | 760-727-4225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. JOHN BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-727-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------