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3211 Business Park Dr Suite A Vista CA 92081-8529 | |
| (760) 727-5613 | |
| (760) 727-4225 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3211 Business Park Dr, Vista, California |
| Authorized Official Name and Position | Brian D Mudd (ADMIN) |
| Authorized Official Contact | 7607275613 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1477 San Pablo Dr San Marcos CA 92078-4701 Ph: (760) 727-5613 | 3211 Business Park Dr Suite A Vista CA 92081-8529 Ph: (760) 727-5613 |
| NPI Number | 1013285436 |
|---|---|
| Provider Enumeration Date | 12/13/2011 |
| Last Update Date | 10/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013285436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 87 (California) | Primary |
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