| A Medina Professional Dental Corporation | |
|
309 Third Avenue Chula Vista CA 91910-3910 | |
| (619) 420-6030 | |
| (619) 420-9102 |
| Full Name | A Medina Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 309 Third Avenue, Chula Vista, California |
| Authorized Official Name and Position | Alfred A Medina (PRESIDENT) |
| Authorized Official Contact | 6194206030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Medina Professional Dental Corporation 309 Third Avenue Chula Vista CA 91910-3910 Ph: (619) 420-6030 | A Medina Professional Dental Corporation 309 Third Avenue Chula Vista CA 91910-3910 Ph: (619) 420-6030 |
| NPI Number | 1114167186 |
|---|---|
| Provider Enumeration Date | 03/03/2009 |
| Last Update Date | 08/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114167186 | NPI | - | NPPES |
| 000475909 | Other | CA | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 29371 (California) | Primary |
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