| Corporation | |
|
2725 Jefferson Street #6 Carlsbad CA 92008 | |
| (760) 434-3103 | |
| (760) 434-3107 |
| Full Name | Corporation |
|---|---|
| Speciality | Dentist |
| Location | 2725 Jefferson Street, Carlsbad, California |
| Authorized Official Name and Position | Thomas M Richardson (OWNER) |
| Authorized Official Contact | 7604343103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corporation 2725 Jefferson Street #6 Carlsbad CA 92008 Ph: (760) 434-3103 | Corporation 2725 Jefferson Street #6 Carlsbad CA 92008 Ph: (760) 434-3103 |
| NPI Number | 1275691958 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275691958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | () | Primary |
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