Provider Demographics
NPI:1871014712
Name:DR MCHALE'S VALLEY CENTER DENTAL GROUP APC
Entity Type:Organization
Organization Name:DR MCHALE'S VALLEY CENTER DENTAL GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MCHALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-749-1123
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-0928
Mailing Address - Country:US
Mailing Address - Phone:760-749-1123
Mailing Address - Fax:760-749-6593
Practice Address - Street 1:28743 VALLEY CENTER RD STE A
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6530
Practice Address - Country:US
Practice Address - Phone:760-749-1123
Practice Address - Fax:760-749-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty