Provider Demographics
NPI:1376638296
Name:THE DENTAL OFFICES OF DR MCMAHAN DDS AND DR ROSELL DDS INC
Entity Type:Organization
Organization Name:THE DENTAL OFFICES OF DR MCMAHAN DDS AND DR ROSELL DDS INC
Other - Org Name:OCEANVIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-721-1022
Mailing Address - Street 1:2420 VISTA WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6190
Mailing Address - Country:US
Mailing Address - Phone:760-721-1022
Mailing Address - Fax:760-721-1431
Practice Address - Street 1:2420 VISTA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6190
Practice Address - Country:US
Practice Address - Phone:760-721-1022
Practice Address - Fax:760-721-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372821223G0001X
CA378721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty