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General NPI Number Information
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NPI Number | 1265767644
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Entity Type | Organization
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Legal Business Name | MISSION VALLEY ORAL & MAXILLOFACIAL SURGERY, INC.
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 2878 CAMINO DEL RIO S SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92108-3872
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Country | US
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Telephone | 619-298-2200
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Fax | 619-298-2250
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Provider Business Mailing Address
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Address Line | 2878 CAMINO DEL RIO S SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92108-3872
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Country | US
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Telephone | 619-298-2200
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Fax | 619-298-2250
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Authorized Official
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Title or Position | PARTNER
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Name | DR. FREDERICK WHITE HAMMOND
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Credential | DDS
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Telephone | 619-298-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 31922
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License Number State | CA
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