Provider Demographics
NPI:1659906055
Name:JONATHAN D ALBAUGH DMD INC
Entity Type:Organization
Organization Name:JONATHAN D ALBAUGH DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-527-2846
Mailing Address - Street 1:30 MAIN ST STE G-140
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5860
Mailing Address - Country:US
Mailing Address - Phone:760-527-2846
Mailing Address - Fax:760-842-0430
Practice Address - Street 1:30 MAIN ST STE G-140
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5860
Practice Address - Country:US
Practice Address - Phone:760-527-2846
Practice Address - Fax:760-842-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225262371OtherNPPES