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General NPI Number Information
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NPI Number | 1972271344
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Entity Type | Organization
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Legal Business Name | DR RUSEN ELSINORE FRIENDLY SMILES DENTAL INC
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 2503 E LAKESHORE DR STE E
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4433
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Country | US
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Telephone | 951-674-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 2503 E LAKESHORE DR STE E
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RARES D RUSEN
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Credential | DDS
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Telephone | 213-324-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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