Provider Demographics
NPI:1588830707
Name:QAQISH, CLEMENT S (MD, DDS)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:S
Last Name:QAQISH
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10672 WEXFORD ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3969
Mailing Address - Country:US
Mailing Address - Phone:858-263-1800
Mailing Address - Fax:858-263-1801
Practice Address - Street 1:10672 WEXFORD ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3969
Practice Address - Country:US
Practice Address - Phone:858-263-1800
Practice Address - Fax:858-263-1801
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery