# ADVANCED DENTISTRY OF SAN DIEGO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477991404
- **Authorized official:** DR. MICHAEL C MAKSIM DDS (OWNER)
- **Authorized official phone:** (760) 726-5703

## Contact information

- **Practice address:** 630 S MELROSE DR STE B, VISTA, CA 92081-6626
- **Practice address phone:** (760) 726-5703
- **Mailing address:** 630 S MELROSE DR STE B, VISTA, CA 92081-6626
- **Mailing address phone:** (760) 726-5703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 35429 | CA | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 06/12/2013