Basic Information
Provider Information
NPI: 1265527030
EntityType: 2
ReplacementNPI:  
OrganizationName: DALTON AND RYGG DENTAL CORPORATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: POWAY FAMILY DENTAL GROUP
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17000 RED HILL AVE
Address2:  
City: IRVINE
State: CA
PostalCode: 926145626
CountryCode: US
TelephoneNumber: 7148458890
FaxNumber: 9494741495
Practice Location
Address1: 13616 POWAY RD
Address2: STE. 100
City: POWAY
State: CA
PostalCode: 920646548
CountryCode: US
TelephoneNumber: 8583919300
FaxNumber: 8583919449
Other Information
ProviderEnumerationDate: 10/04/2006
LastUpdateDate: 11/12/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RYGG
AuthorizedOfficialFirstName: LANCE
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: OWNER DDS
AuthorizedOfficialTelephone: 8583919300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DDS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X  Y193200000X MULTI-SPECIALTY GROUPDental ProvidersDentistGeneral Practice

No ID Information.


Home