Provider Demographics
NPI:1679641377
Name:FOSSETT, DOUGLAS J (DDS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:FOSSETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 CUYAMACA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4373
Mailing Address - Country:US
Mailing Address - Phone:619-448-8387
Mailing Address - Fax:619-258-8819
Practice Address - Street 1:8770 CUYAMACA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4373
Practice Address - Country:US
Practice Address - Phone:619-448-8387
Practice Address - Fax:619-258-8819
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB255201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice