Provider Demographics
NPI:1619421815
Name:SINCLAIR, MARISELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISELA
Middle Name:
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 N EL CAMINO REAL STE C102
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1347
Mailing Address - Country:US
Mailing Address - Phone:760-753-3368
Mailing Address - Fax:760-753-3365
Practice Address - Street 1:499 N EL CAMINO REAL STE C102
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1347
Practice Address - Country:US
Practice Address - Phone:760-487-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1006501223G0001X
CA1006501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619421815OtherNPI