| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12350 Oak Knoll Rd, Poway, California |
| Authorized Official Name and Position | Jodi A Mcgrady (DENTIST) |
| Authorized Official Contact | 8587483090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12350 Oak Knoll Rd Poway CA 92064-5320 Ph: (858) 748-3090 | 12350 Oak Knoll Rd Poway CA 92064 Ph: (858) 748-3090 |
| NPI Number | 1720576671 |
|---|---|
| Provider Enumeration Date | 04/26/2018 |
| Last Update Date | 06/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720576671 | NPI | - | NPPES |
| 1548316391 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 57570 (California) | Primary |
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