MEDICARE: DR. SUMUL QAISAR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	59762	CA

General Provider Information

NPI Number	:	1043582687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMUL QAISAR D.D.S.

Provider Business Mailing Address
First Line	:	10275 CARMEL MOUNTAIN RD
Second Line	:	# 210
City	:	SAN DIEGO
State	:	CA
Zip	:	92128
Country	:	US
Telephone Number	:	858-487-6453
Fax Number	:

Provider Business Practice Location Address
First Line	:	12075 CARMEL MOUNTAIN RD STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4613
Country	:	US
Telephone Number	:	858-487-6453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/07/2022

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