Provider Demographics
NPI:1053653527
Name:DENTAL CARE MANAGEMENT, INC
Entity Type:Organization
Organization Name:DENTAL CARE MANAGEMENT, INC
Other - Org Name:BUSINESS PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-727-6800
Mailing Address - Street 1:1477 SAN PABLO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4701
Mailing Address - Country:US
Mailing Address - Phone:760-727-6800
Mailing Address - Fax:760-727-4225
Practice Address - Street 1:3211 BUSINESS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8259
Practice Address - Country:US
Practice Address - Phone:760-727-6800
Practice Address - Fax:760-727-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty