Provider Demographics
NPI:1023337474
Name:BRESSI RANCH FAMILY DENTISTRY
Entity type:Organization
Organization Name:BRESSI RANCH FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-602-9500
Mailing Address - Street 1:6221 METROPOLITAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-3096
Mailing Address - Country:US
Mailing Address - Phone:760-602-9500
Mailing Address - Fax:760-602-9510
Practice Address - Street 1:6221 METROPOLITAN ST STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-3096
Practice Address - Country:US
Practice Address - Phone:760-602-9500
Practice Address - Fax:760-602-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443731223G0001X
CA447311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty