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Organization
DUANE NOWACK A PROFESSIONAL DENTAL CORPORATION
Active
Organization
DUANE NOWACK A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE C NOWACK D.D.S. (OWNER)
(760) 789-7002
Entity
Organization
Contact information
Practice address
1721 MAIN ST STE 108, RAMONA, CA 92065-2240
(760) 789-7002
Mailing address
1721 MAIN ST STE 108, RAMONA, CA 92065-2240
(760) 789-7002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
541022
PROV. # UNITED CONCORDIA
CA
01
—
B-15103-01
MEDI- CAL
CA
Enumeration date
01/22/2007
Last updated
08/22/2020
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