| Portilla Dental Group Corp | |
|
200 N Ash St Ste 200 Escondido CA 92027-3024 | |
| (760) 738-8300 | |
| (760) 738-9400 |
| Full Name | Portilla Dental Group Corp |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 200 N Ash St Ste 200, Escondido, California |
| Authorized Official Name and Position | Harold Ignacio Portilla (PRESIDENT OWNER) |
| Authorized Official Contact | 7607388300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portilla Dental Group Corp 200 N Ash St Ste 200 Escondido CA 92027-3024 Ph: (760) 738-8300 | Portilla Dental Group Corp 200 N Ash St Ste 200 Escondido CA 92027-3024 Ph: (760) 738-8300 |
| NPI Number | 1457957185 |
|---|---|
| Provider Enumeration Date | 12/08/2020 |
| Last Update Date | 12/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457957185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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