NPI 1104286996

McCormack Dental Imaging

Organisation Dental Laboratory Encinitas, CA

Practice location

Address: 317 N El Camino Real STE. 301, Encinitas, CA 92024-2811
Phone: (760) 942-2133
Mailing address: 450 Sutter St STE. 1542, San Francisco, CA 94108-4206

Authorised official

Name: Jerome N. Peck
Title: Ceo
Phone: (415) 421-1389

Registered specialties

Dental Laboratory Primary

Laboratories Taxonomy 292200000X Licence RHP00053519 (CA)

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Registry record

NPI: 1104286996
Entity type: Organization
NPI issued: 7 Mar 2016
Record last updated: 7 Mar 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.