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General NPI Number Information
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NPI Number | 1609205426
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Entity Type | Organization
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Legal Business Name | VIDA NAMAVAR D.D.S., INC.
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 670 W SAN MARCOS BLVD SUITE 103
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City | SAN MARCOS
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State | CA
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Zip | 92078-1235
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Country | US
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Telephone | 619-850-9320
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Fax |
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Provider Business Mailing Address
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Address Line | 670 W SAN MARCOS BLVD SUITE 103
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City | SAN MARCOS
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State | CA
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Zip | 92078-1235
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Country | US
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Telephone | 619-850-9320
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | DR. VIDA NAMAVAR
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Credential | D.D.S
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Telephone | 619-850-9320
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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 |
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License Number State |
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