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General NPI Number Information
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NPI Number | 1154491975
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Entity Type | Organization
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Legal Business Name | JOSE A DRAGO RUTH I DRAGO DDS INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 951 E VISTA WAY
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City | VISTA
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State | CA
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Zip | 92084
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Country | US
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Telephone | 760-732-1428
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Fax | 760-732-0192
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Provider Business Mailing Address
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Address Line | 951 E VISTA WAY
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City | VISTA
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State | CA
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Zip | 92084
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Country | US
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Telephone | 760-732-1428
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Fax | 760-732-0192
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Authorized Official
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Title or Position | OWNER
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Name | JOSE DRAGO
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Credential | DDS
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Telephone | 760-732-1428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47072
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47879
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License Number State | CA
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