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12378 Poway Rd Ste B Poway CA 92064-4242 | |
| (858) 679-8918 | |
| (858) 679-6979 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12378 Poway Rd Ste B, Poway, California |
| Authorized Official Name and Position | Ning Liu (PRESIDENT DENTIST) |
| Authorized Official Contact | 8586798918 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12378 Poway Rd Ste B Poway CA 92064-4242 Ph: (858) 679-8918 | 12378 Poway Rd Ste B Poway CA 92064-4242 Ph: (858) 679-8918 |
| NPI Number | 1477769685 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477769685 | NPI | - | NPPES |
| G92459-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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