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General NPI Number Information
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NPI Number | 1376832394
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Entity Type | Organization
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Legal Business Name | VALE TERRACE DENTAL GROUP
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 933 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5213
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Country | US
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Telephone | 760-724-1011
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Fax | 760-480-4921
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Provider Business Mailing Address
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Address Line | 933 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5213
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Country | US
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Telephone | 760-724-1011
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Fax | 760-480-4921
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT TODD MCMASTER
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Credential | D.D.S
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Telephone | 760-724-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43200
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License Number State | CA
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