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General NPI Number Information
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NPI Number | 1114472693
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Entity Type | Organization
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Legal Business Name | PACKARD DENTAL PARTNERSHIP
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 1281 CARLSBAD VILLAGE DR
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City | CARLSBAD
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State | CA
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Zip | 92008-1950
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Country | US
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Telephone | 760-729-4904
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Fax | 760-729-3132
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Provider Business Mailing Address
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Address Line | 1281 CARLSBAD VILLAGE DR
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City | CARLSBAD
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State | CA
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Zip | 92008-1950
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Country | US
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Telephone | 760-729-4904
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Fax | 760-729-3132
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. MATTHEW S PACKARD
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Credential | DDS
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Telephone | 760-729-4904
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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 | 60498
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License Number State | CA
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