David Phan DDS Dental Corporation

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

DAVID PHAN DDS DENTAL CORPORATION

Doing business as

Temecula Oral Surgery

Practice address

27699 Jefferson Ave Ste 110
Temecula, CA 92590-2697

Phone

(951) 501-8728

Fax

(951) 501-8730

NPI assigned

Feb 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Phan, DMD

Title

Owner

Phone

(951) 501-8728

Specialties & licenses 1

Addresses

Other names 1

• Temecula Oral Surgery Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1912599432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE STE 110",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902697",
            "telephone_number": "951-501-8728",
            "fax_number": "951-501-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27699 JEFFERSON AVE STE 110",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925902697",
            "telephone_number": "951-501-8728",
            "fax_number": "951-501-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID PHAN DDS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-501-8728",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temecula Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Temecula, CA
• Providers in Temecula, CA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.