# A MEDINA PROFESSIONAL DENTAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114167186
- **Authorized official:** DR. ALFRED A MEDINA D.D.S. (PRESIDENT)
- **Authorized official phone:** (619) 420-6030

## Contact information

- **Practice address:** 309 THIRD AVENUE, CHULA VISTA, CA 91910-3910
- **Practice address phone:** (619) 420-6030
- **Practice address fax:** (619) 420-9102
- **Mailing address:** 309 THIRD AVENUE, CHULA VISTA, CA 91910-3910
- **Mailing address phone:** (619) 420-6030
- **Mailing address fax:** (619) 420-9102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 29371 | CA | Yes |

## Other

- **Enumeration date:** 03/03/2009
- **Last updated:** 08/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000475909 | UNITED CONCORDIA | CA |