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General NPI Number Information
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NPI Number | 1528599305
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Entity Type | Organization
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Legal Business Name | MCANINCH DENTAL GROUP, INC.
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 1111 EAST OCEAN AVENUE SUITE 9
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City | LOMPOC
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State | CA
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Zip | 93436
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Country | US
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Telephone | 805-735-3665
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Fax | 805-735-5665
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Provider Business Mailing Address
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Address Line | 1111 EAST OCEAN AVENUE SUITE 9
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City | LOMPOC
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State | CA
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Zip | 93436
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Country | US
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Telephone | 805-735-3665
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Fax | 805-735-5665
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LEWIS MCANINCH IV
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Credential | DDS
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Telephone | 805-735-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 62204
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License Number State | CA
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