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General NPI Number Information
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NPI Number | 1477700730
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Entity Type | Organization
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Legal Business Name | EUSEBIO DENTAL CORPORATION
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 1127 HIGHLAND AVENUE
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 619-336-6063
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Fax | 619-336-6066
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Provider Business Mailing Address
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Address Line | 1127 HIGHLAND AVENUE
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 619-336-6063
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Fax | 619-336-6066
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ERIC JOHN R EUSEBIO
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Credential | DMD
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Telephone | 619-336-6063
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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 | 43439
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License Number State | CA
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