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General NPI Number Information
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NPI Number | 1174955868
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Entity Type | Organization
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Legal Business Name | PACKARD DENTAL GROUP INC.
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 725 GRAND AVE
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City | CARLSBAD
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State | CA
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Zip | 92008-2331
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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 | 725 GRAND AVE
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City | CARLSBAD
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State | CA
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Zip | 92008-2331
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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 | DR/OWNER
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Name | DR. MARK D. PACKARD
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Credential | D.M.D.
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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