Provider Demographics
NPI:1023350071
Name:TWICHEL, JOHN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:TWICHEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 TOWN CENTER PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5811
Mailing Address - Country:US
Mailing Address - Phone:619-449-8622
Mailing Address - Fax:619-334-2350
Practice Address - Street 1:235 TOWN CENTER PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5811
Practice Address - Country:US
Practice Address - Phone:619-449-8622
Practice Address - Fax:619-334-2350
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice