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Organization
MIRA MESA DENTAL & ORTHODONTIC OFFICE
Active
Organization
MIRA MESA DENTAL & ORTHODONTIC OFFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA A JOHNSON (ADMINISTRATOR)
(858) 566-5050
Entity
Organization
Contact information
Practice address
9750 MIRAMAR ROAD, SUITE 260, SAN DIEGO, CA 92126
(858) 566-5050
(858) 566-7414
Mailing address
9750 MIRAMAR ROAD, SUITE 260, SAN DIEGO, CA 92126
(858) 566-5050
(858) 566-7414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
858859
UNITED CONCORDIA INS
CA
Enumeration date
10/31/2006
Last updated
08/22/2020
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