| La Jolla Dental Specialty Group | |
|
4510 Executive Dr Suite 205 San Diego CA 92121-3021 | |
| (858) 546-1802 | |
| (858) 546-1242 |
| Full Name | La Jolla Dental Specialty Group |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 4510 Executive Dr, San Diego, California |
| Authorized Official Name and Position | Duke Huynh Nguyen (OWNER) |
| Authorized Official Contact | 8585461802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Jolla Dental Specialty Group 4510 Executive Dr Suite 205 San Diego CA 92121-3021 Ph: (858) 546-1802 | La Jolla Dental Specialty Group 4510 Executive Dr Suite 205 San Diego CA 92121-3021 Ph: (858) 546-1802 |
| NPI Number | 1316171937 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 05/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316171937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 47399 (California) | Primary |
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