Provider Demographics
NPI:1962538512
Name:NELSON B MUSGRAVE DDS INC
Entity type:Organization
Organization Name:NELSON B MUSGRAVE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-741-5092
Mailing Address - Street 1:1357 HINRICHS WAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-4136
Mailing Address - Country:US
Mailing Address - Phone:760-741-5092
Mailing Address - Fax:
Practice Address - Street 1:2302 BROWN ROAD
Practice Address - Street 2:DENTAL DEPT
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-0731
Practice Address - Country:US
Practice Address - Phone:760-733-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty