Provider Demographics
NPI:1629271952
Name:JOHN W. FRUIN DDS, INC.
Entity Type:Organization
Organization Name:JOHN W. FRUIN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:FRUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-634-8100
Mailing Address - Street 1:3257 CAINO DE LOS COCHES 306
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009
Mailing Address - Country:US
Mailing Address - Phone:760-634-8100
Mailing Address - Fax:760-634-8130
Practice Address - Street 1:3257 CAINO DE LOS COCHES 306
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009
Practice Address - Country:US
Practice Address - Phone:760-634-8100
Practice Address - Fax:760-634-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty