| Park Blvd Oral Surgery | |
|
4067 Park Blvd San Diego CA 92103-2619 | |
| (619) 795-0154 | |
| (619) 795-0512 |
| Full Name | Park Blvd Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4067 Park Blvd, San Diego, California |
| Authorized Official Name and Position | Stjepan Steven Podstreleny (OWNER) |
| Authorized Official Contact | 6197950154 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Blvd Oral Surgery 4067 Park Blvd San Diego CA 92103-2619 Ph: (619) 795-0154 | Park Blvd Oral Surgery 4067 Park Blvd San Diego CA 92103-2619 Ph: (619) 795-0154 |
| NPI Number | 1023322468 |
|---|---|
| Provider Enumeration Date | 07/27/2010 |
| Last Update Date | 07/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023322468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 50861 (California) | Primary |
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