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General NPI Number Information
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NPI Number | 1497139703
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Entity Type | Organization
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Legal Business Name | FRED T. POWERS JR., DMD, INC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 27701 SCOTT RD D-107
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City | MENIFEE
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State | CA
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Zip | 92584-9417
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Country | US
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Telephone | 951-301-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 27701 SCOTT RD D-107
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City | MENIFEE
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State | CA
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Zip | 92584-9417
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Country | US
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Telephone | 951-301-6100
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Fax |
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Authorized Official
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Title or Position | OWNER/OFFICE MANAGER
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Name | DAWN R POWERS
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Credential |
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Telephone | 951-301-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 33356
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License Number State | CA
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