Charles Leo Drury, DDS
Individual provider Active NPI Dentist · Bonsall, CA
NPI 1003014093 · NPPES record last updated Jul 11, 2007
Key facts
- NPI
- 1003014093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 48905 (CA)
- Practice address
- 5256 S Misson Rd
Suite 1101
Bonsall, CA 92003-3624 - Phone
- (760) 630-5500
- Fax
- (760) 630-5831
- NPI assigned
- Jul 11, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48905 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 48905 | CA | Yes |
Addresses
Primary practice location
5256 S Misson Rd
Suite 1101
Bonsall, CA 92003-3624
Mailing address
5256 S Misson Rd
Suite 1101
Bonsall, CA 92003-3624
Phone (760) 630-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1753898 | Other | UNITED CONCORDIA | |
| 48905 | Other | DELTA |
Other providers in Bonsall, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.