| Otay Lakes Smiles | |
|
2452 Fenton Street Suite C-200 Chula Vista CA 91914 | |
| (619) 934-6620 | |
| (619) 934-4503 |
| Full Name | Otay Lakes Smiles |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2452 Fenton Street, Chula Vista, California |
| Authorized Official Name and Position | Guadalupe Marquez (PRESIDENT) |
| Authorized Official Contact | 6199346620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otay Lakes Smiles 2452 Fenton Street Suite C-200 Chula Vista CA 91914 Ph: (619) 934-6620 | Otay Lakes Smiles 2452 Fenton Street Suite C-200 Chula Vista CA 91914 Ph: (619) 934-6620 |
| NPI Number | 1407058845 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 08/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407058845 | NPI | - | NPPES |
| B38716-01 | Other | CA | DENTICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 38716 (California) | Primary |
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