Provider Demographics
NPI:1255346698
Name:DR. TED A WASSEL, DDS, INC.
Entity type:Organization
Organization Name:DR. TED A WASSEL, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:ALBERS
Authorized Official - Last Name:WASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-744-1320
Mailing Address - Street 1:1030 LA BONITA DRIVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078
Mailing Address - Country:US
Mailing Address - Phone:760-744-1919
Mailing Address - Fax:760-744-4625
Practice Address - Street 1:1030 LA BONITA DRIVE
Practice Address - Street 2:SUITE 322
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078
Practice Address - Country:US
Practice Address - Phone:760-744-1919
Practice Address - Fax:760-744-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty