Provider Demographics
NPI:1073887667
Name:POISET DENTAL GROUP, APC
Entity Type:Organization
Organization Name:POISET DENTAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:POISET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-492-9977
Mailing Address - Street 1:7930 FROST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2737
Mailing Address - Country:US
Mailing Address - Phone:858-492-9977
Mailing Address - Fax:858-492-9910
Practice Address - Street 1:7930 FROST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2737
Practice Address - Country:US
Practice Address - Phone:858-492-9977
Practice Address - Fax:858-492-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty