Provider Demographics
NPI:1457414674
Name:ESCALANTE, RAUL ENRIQUE (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ENRIQUE
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 NORDAHL RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3595
Mailing Address - Country:US
Mailing Address - Phone:760-743-1161
Mailing Address - Fax:760-743-3367
Practice Address - Street 1:838 NORDAHL RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3595
Practice Address - Country:US
Practice Address - Phone:760-743-1161
Practice Address - Fax:760-743-3367
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice