Provider Demographics
NPI:1043582687
Name:QAISAR, SUMUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUMUL
Middle Name:
Last Name:QAISAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10275 CARMEL MOUNTAIN RD
Mailing Address - Street 2:# 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-487-6453
Mailing Address - Fax:
Practice Address - Street 1:12075 CARMEL MOUNTAIN RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4613
Practice Address - Country:US
Practice Address - Phone:858-487-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597621223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice