| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2325 S Melrose Dr., Vista, California |
| Authorized Official Name and Position | Houri Fatourachi (PRESIDENT) |
| Authorized Official Contact | 7607344400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2325 S Melrose Dr Vista CA 92081-8788 Ph: (760) 734-4400 | 2325 S Melrose Dr. Vista CA 92081 Ph: (760) 734-4400 |
| NPI Number | 1184069122 |
|---|---|
| Provider Enumeration Date | 05/03/2013 |
| Last Update Date | 05/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184069122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 47887 (California) | Primary |
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