Provider Demographics
NPI:1003211327
Name:CARLSBAD DENTAL ARTS
Entity Type:Organization
Organization Name:CARLSBAD DENTAL ARTS
Other - Org Name:MAROON DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-930-4300
Mailing Address - Street 1:2521 PALOMAR AIRPORT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1511
Mailing Address - Country:US
Mailing Address - Phone:760-930-4300
Mailing Address - Fax:760-930-4302
Practice Address - Street 1:2521 PALOMAR AIRPORT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1511
Practice Address - Country:US
Practice Address - Phone:760-930-4300
Practice Address - Fax:760-930-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty