Provider Demographics
NPI:1104543792
Name:DEEP MUKO DDS, INC.
Entity type:Organization
Organization Name:DEEP MUKO DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-654-2121
Mailing Address - Street 1:32605 TEMECULA PARKWAY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-303-2818
Mailing Address - Fax:951-303-6123
Practice Address - Street 1:1695 S SAN JACINTO AVE STE N
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5104
Practice Address - Country:US
Practice Address - Phone:951-654-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty