Provider Demographics
NPI:1669509311
Name:J. MICHAEL TWICHEL DMD INC.
Entity Type:Organization
Organization Name:J. MICHAEL TWICHEL DMD INC.
Other - Org Name:SANTEE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TWICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-449-8622
Mailing Address - Street 1:235 TOWN CENTER PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5811
Mailing Address - Country:US
Mailing Address - Phone:619-449-8622
Mailing Address - Fax:619-449-8649
Practice Address - Street 1:235 TOWN CENTER PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5811
Practice Address - Country:US
Practice Address - Phone:619-449-8622
Practice Address - Fax:619-449-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA771559OtherUNITED CONCORDIA