Provider Demographics
NPI:1124795208
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:DR
Authorized Official - First Name:DEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-303-2818
Mailing Address - Street 1:32605 TEMECULA PKWY STE 213
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6839
Mailing Address - Country:US
Mailing Address - Phone:951-303-2818
Mailing Address - Fax:951-303-6213
Practice Address - Street 1:32605 TEMECULA PKWY STE 213
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6839
Practice Address - Country:US
Practice Address - Phone:951-303-2818
Practice Address - Fax:951-303-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0407OtherGENERAL DENTISTRY PRACTICE