Provider Demographics
NPI:1275068108
Name:DAOUD AND EISSA DENTAL INC.
Entity Type:Organization
Organization Name:DAOUD AND EISSA DENTAL INC.
Other - Org Name:DELMAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:EISSA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:763-587-8345
Mailing Address - Street 1:1010 E VISTA WAY
Mailing Address - Street 2:STE A
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4607
Mailing Address - Country:US
Mailing Address - Phone:760-659-6118
Mailing Address - Fax:760-659-6431
Practice Address - Street 1:1010 E VISTA WAY
Practice Address - Street 2:STE A
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4607
Practice Address - Country:US
Practice Address - Phone:760-659-6118
Practice Address - Fax:760-659-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty