Provider Demographics
NPI:1407866791
Name:TEMECULA CREEK DENTAL CARE
Entity Type:Organization
Organization Name:TEMECULA CREEK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELCEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-308-2183
Mailing Address - Street 1:31333 TEMECULA PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-308-2183
Mailing Address - Fax:951-308-2158
Practice Address - Street 1:31333 TEMECULA PKWY
Practice Address - Street 2:STE 110
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-308-2183
Practice Address - Fax:951-308-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty