MEDICARE: ESCONDIDO ENDODONTICS INC

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	1223E0200X	Endodontics	37237	CA
2	1223E0200X	Endodontics	43444	CA

General Provider Information

NPI Number	:	1497810790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESCONDIDO ENDODONTICS INC

Provider Business Mailing Address
First Line	:	488 EAST VALLEY PARKWAY
Second Line	:	SUITE 307
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3373
Country	:	US
Telephone Number	:	760-739-1400
Fax Number	:	760-739-1100

Provider Business Practice Location Address
First Line	:	488 EAST VALLEY PARKWAY
Second Line	:	SUITE 307
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3373
Country	:	US
Telephone Number	:	760-739-1400
Fax Number	:	760-739-1100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT JOSEPH HANLON JR.
Credential	:	DMD
Telephone Number	:	760-739-1400

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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Directions to “ESCONDIDO ENDODONTICS INC ” Practice Location

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