# MIGUEL GRILLO, DMD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prosthodontic Specialist of San Diego
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831414200
- **Authorized official:** MRS. VANESSA L CARRILLO (OFFICE MANAGER)
- **Authorized official phone:** (858) 755-9810

## Contact information

- **Practice address:** 12264 EL CAMINO REAL STE 306, SAN DIEGO, CA 92130-3062
- **Practice address phone:** (858) 755-9810
- **Practice address fax:** (858) 755-9813
- **Mailing address:** 12264 EL CAMINO REAL STE 306, SAN DIEGO, CA 92130-3062
- **Mailing address phone:** (858) 755-9810
- **Mailing address fax:** (858) 755-9813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | 41411 | CA | Yes |

## Other

- **Enumeration date:** 03/29/2010
- **Last updated:** 03/29/2010