Organization
PELICAN POINT DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE ELIZABETH KUSKE DDS (DENTIST)
(562) 964-0877
Entity
Organization
Contact information
Practice address
31103 RANCHO VIEJO ROAD STE D2444, SAN JUAN CAPISTRANO, CA 92675
(562) 964-0877
Mailing address
31103 RANCHO VIEJO ROAD STE D2444, SAN JUAN CAPISTRANO, CA 92675
(562) 964-0877
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
57535
CA
1223D0001X
Public Health Dentistry
Primary
57535
CA
1223G0001X
General Practice Dentistry
57535
CA
Other
Enumeration date
04/17/2018
Last updated
04/17/2018
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