# 4030 DENTAL INC.

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

## Provider details

- **NPI number:** 1275833956
- **Authorized official:** MRS. RAWAA ALDAIRI (PRESIDENT)
- **Authorized official phone:** (630) 567-6373

## Contact information

- **Practice address:** 6175 EL CAJON BLVD, SAN DIEGO, CA 92115-3915
- **Practice address phone:** (630) 567-6373
- **Mailing address:** 6175 EL CAJON BLVD, SAN DIEGO, CA 92115-3915
- **Mailing address phone:** (619) 583-4030

## Taxonomy

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

## Other

- **Enumeration date:** 10/27/2010
- **Last updated:** 10/27/2010