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General NPI Number Information
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NPI Number | 1063801025
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Entity Type | Organization
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Legal Business Name | J MAROON DDS INC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 257 N EL CAMINO REAL STE B
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City | ENCINITAS
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State | CA
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Zip | 92024-5365
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Country | US
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Telephone | 760-944-7600
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Fax | 760-944-7610
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Provider Business Mailing Address
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Address Line | 257 N EL CAMINO REAL STE B
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City | ENCINITAS
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State | CA
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Zip | 92024-5365
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Country | US
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Telephone | 760-944-7600
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Fax | 760-944-7610
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JOHN MAROON
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Credential | D.D.S
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Telephone | 760-944-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40671
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License Number State | CA
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