Provider Demographics
NPI:1497139703
Name:FRED T. POWERS JR., DMD, INC
Entity Type:Organization
Organization Name:FRED T. POWERS JR., DMD, INC
Other - Org Name:POWERS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-301-6100
Mailing Address - Street 1:27701 SCOTT RD
Mailing Address - Street 2:D-107
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9417
Mailing Address - Country:US
Mailing Address - Phone:951-301-6100
Mailing Address - Fax:
Practice Address - Street 1:27701 SCOTT RD
Practice Address - Street 2:D-107
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9417
Practice Address - Country:US
Practice Address - Phone:951-301-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33356305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013058551OtherDEACTIVATED NPI DUE TO DEATH OF HEALTH CARE PROVIDER