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Organization
MARK R MEDINA & THOMAS KERRIAN
Active
Organization
MARK R MEDINA & THOMAS KERRIAN
Active
Other names
Rancho Penasquitos Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J KERRIAN D.M.D. (DENTIST)
(858) 484-3100
Entity
Organization
Contact information
Practice address
9955 CARMEL MOUNTAIN RD STE 4, SAN DIEGO, CA 92129-2815
(858) 484-3100
(858) 484-8510
Mailing address
9955 CARMEL MOUNTAIN RD STE 4, SAN DIEGO, CA 92129-2815
(858) 484-3100
(858) 484-8510
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
25595
CA
1223G0001X
General Practice Dentistry
Primary
31129
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25595
STATE ID
CA
01
—
31129
STATE ID
CA
Enumeration date
08/20/2006
Last updated
07/17/2008
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