1255346698 NPI number — DR. TED A WASSEL, DDS, INC.

Table of content: (NPI 1255346698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255346698 NPI number — DR. TED A WASSEL, DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. TED A WASSEL, DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TED A WASSEL, DDS, INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255346698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 LA BONITA DRIVE
Provider Second Line Business Mailing Address:
SUITE 322
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-744-1919
Provider Business Mailing Address Fax Number:
760-744-4625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 LA BONITA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-744-1919
Provider Business Practice Location Address Fax Number:
760-744-4625
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASSEL
Authorized Official First Name:
TED
Authorized Official Middle Name:
ALBERS
Authorized Official Title or Position:
PRESIDENT/OWNER/DENTIST
Authorized Official Telephone Number:
760-744-1320

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  40040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)