| Dr. Ellen Im Pediatric Dentistry And Orthodontics | |
|
13422 Pomerado Rd Ste 201 Poway CA 92064-3548 | |
| (858) 679-6660 | |
| Not Available |
| Full Name | Dr. Ellen Im Pediatric Dentistry And Orthodontics |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 13422 Pomerado Rd Ste 201, Poway, California |
| Authorized Official Name and Position | Ellen Im (OWNER/OPERATOR) |
| Authorized Official Contact | 8586796660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Ellen Im Pediatric Dentistry And Orthodontics 13422 Pomerado Rd Ste 201 Poway CA 92064-3548 Ph: () - | Dr. Ellen Im Pediatric Dentistry And Orthodontics 13422 Pomerado Rd Ste 201 Poway CA 92064-3548 Ph: (858) 679-6660 |
| NPI Number | 1861091720 |
|---|---|
| Provider Enumeration Date | 10/21/2020 |
| Last Update Date | 05/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861091720 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
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