Provider Demographics
NPI:1275753915
Name:DOUGLAS J. FOSSETT, DDS
Entity Type:Organization
Organization Name:DOUGLAS J. FOSSETT, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-448-8387
Mailing Address - Street 1:8770 CUYAMACA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4373
Mailing Address - Country:US
Mailing Address - Phone:619-448-8387
Mailing Address - Fax:619-258-8819
Practice Address - Street 1:8770 CUYAMACA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4373
Practice Address - Country:US
Practice Address - Phone:619-448-8387
Practice Address - Fax:619-258-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAF9358791261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental