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General NPI Number Information
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NPI Number | 1275753915
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Entity Type | Organization
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Legal Business Name | DOUGLAS J. FOSSETT, DDS
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8770 CUYAMACA ST SUITE 1
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City | SANTEE
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State | CA
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Zip | 92071-4373
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Country | US
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Telephone | 619-448-8387
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Fax | 619-258-8819
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Provider Business Mailing Address
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Address Line | 8770 CUYAMACA ST SUITE 1
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City | SANTEE
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State | CA
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Zip | 92071-4373
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Country | US
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Telephone | 619-448-8387
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Fax | 619-258-8819
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Authorized Official
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Title or Position | DENTIST
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Name | MR. DOUGLAS J. FOSSETT
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Credential | D.D.S.
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Telephone | 619-448-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | AF9358791
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License Number State | CA
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