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General NPI Number Information
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NPI Number | 1316119290
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Entity Type | Organization
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Legal Business Name | MCGANN FACIAL DESIGN
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 7910 FROST ST #310
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 858-874-8181
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Fax | 858-429-7010
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Provider Business Mailing Address
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Address Line | 7910 FROST ST #310
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 858-874-8181
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Fax | 858-429-7010
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NATALIA WOLCOFF
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Credential |
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Telephone | 858-874-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 52892
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License Number State | CA
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