Provider Demographics
NPI:1396948527
Name:MEBUST, JAMES ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MEBUST
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 1:4367 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1313
Mailing Address - Country:US
Mailing Address - Phone:619-283-3383
Mailing Address - Fax:619-283-0530
Practice Address - Street 1:4367 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1313
Practice Address - Country:US
Practice Address - Phone:619-283-3383
Practice Address - Fax:619-283-0530
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice