| |
630 Alta Vista Dr #108 Vista CA 92084-5504 | |
(760) 724-6537 | |
(760) 724-5115 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 630 Alta Vista Dr, Vista, California |
Authorized Official Name and Position | George R Braithwaite (DENTIST/PRESIDENT) |
Authorized Official Contact | 7607246537 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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630 Alta Vista Dr #108 Vista CA 92084-5504 Ph: (760) 724-6537 | 630 Alta Vista Dr #108 Vista CA 92084-5504 Ph: (760) 724-6537 |
NPI Number | 1508053323 |
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Provider Enumeration Date | 09/25/2007 |
Last Update Date | 07/27/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508053323 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 24937 (California) | Primary |
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