Organization
A MEDINA PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFRED A MEDINA D.D.S. (PRESIDENT)
(619) 420-6030
Entity
Organization
Contact information
Practice address
309 THIRD AVENUE, CHULA VISTA, CA 91910-3910
(619) 420-6030
(619) 420-9102
Mailing address
309 THIRD AVENUE, CHULA VISTA, CA 91910-3910
(619) 420-6030
(619) 420-9102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29371
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000475909
UNITED CONCORDIA
CA
Enumeration date
03/03/2009
Last updated
08/26/2015
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