# MARISA PODESTO DDS, DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bonita Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588171235
- **Authorized official:** TODD LUDDEN DDS (ASSOCIATE)
- **Authorized official phone:** (619) 267-2115

## Contact information

- **Practice address:** 5050 BONITA RD, BONITA, CA 91902-1701
- **Practice address phone:** (619) 267-2115
- **Practice address fax:** (619) 354-4166
- **Mailing address:** 5050 BONITA RD, BONITA, CA 91902-1701
- **Mailing address phone:** (619) 267-2115
- **Mailing address fax:** (619) 354-4166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 61894 | CA | Yes |

## Other

- **Enumeration date:** 01/03/2018
- **Last updated:** 11/12/2019