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General NPI Number Information
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NPI Number | 1629385380
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Entity Type | Organization
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Legal Business Name | DENTAL SPECIALTY CARE
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1415 BRUNDAGE LN
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City | BAKERSFIELD
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State | CA
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Zip | 93304-3114
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Country | US
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Telephone | 661-323-0076
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Fax |
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Provider Business Mailing Address
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Address Line | 1477 SAN PABLO DR
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City | SAN MARCOS
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State | CA
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Zip | 92078-4701
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Country | US
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Telephone | 619-977-1250
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOHN BAKER
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Credential |
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Telephone | 619-977-1250
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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 | 52768
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License Number State | CA
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