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General NPI Number Information
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NPI Number | 1154159408
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Entity Type | Organization
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Legal Business Name | DEYO DENTAL CORPORATION
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 960 W SAN MARCOS BLVD STE 100
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City | SAN MARCOS
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State | CA
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Zip | 92078-1122
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Country | US
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Telephone | 310-913-9013
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Fax |
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Provider Business Mailing Address
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Address Line | 1293 HOLMGROVE DR
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City | SAN MARCOS
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State | CA
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Zip | 92078-2800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. LAURA DEYO
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Credential | DDS, MS
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Telephone | 310-913-9013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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