Provider Demographics
NPI:1255790101
Name:REPPAS & EL-MAASRI DENTAL INC.
Entity type:Organization
Organization Name:REPPAS & EL-MAASRI DENTAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:EL-MAASRI
Authorized Official - Last Name:REPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-798-4178
Mailing Address - Street 1:1 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2918
Mailing Address - Country:US
Mailing Address - Phone:760-798-4178
Mailing Address - Fax:760-798-0564
Practice Address - Street 1:1 CIVIC CENTER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2918
Practice Address - Country:US
Practice Address - Phone:760-798-4178
Practice Address - Fax:760-798-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty