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General NPI Number Information
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NPI Number | 1275068108
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Entity Type | Organization
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Legal Business Name | DAOUD AND EISSA DENTAL INC.
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 1010 E VISTA WAY STE A
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City | VISTA
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State | CA
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Zip | 92084-4607
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Country | US
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Telephone | 760-659-6118
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Fax | 760-659-6431
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Provider Business Mailing Address
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Address Line | 1010 E VISTA WAY STE A
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City | VISTA
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State | CA
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Zip | 92084-4607
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Country | US
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Telephone | 760-659-6118
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Fax | 760-659-6431
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Authorized Official
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Title or Position | OFFICER
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Name | DR. KHALED EISSA
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Credential | BDS
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Telephone | 763-587-8345
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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 | 59237
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License Number State | CA
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