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General NPI Number Information
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NPI Number | 1174078745
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Entity Type | Organization
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Legal Business Name | OSCAR A BRACAMONTES DDS
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 1144 13TH ST SUITE 102
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-3675
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Country | US
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Telephone | 619-946-1071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | IMPERIAL BEACH
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State | CA
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Zip | 91933-0999
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Country | US
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Telephone | 619-778-6765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OSCAR A BRACAMONTES
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Credential | DDS
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Telephone | 619-946-1071
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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 | 2763785
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License Number State | CA
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