Organization
GRACE NANTALE DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRACE TRAVERS DDS (OWNER DENTIST)
(312) 342-2299
Entity
Organization
Contact information
Practice address
828 JACKMAN ST, EL CAJON, CA 92020-3053
(619) 343-8167
Mailing address
828 JACKMAN ST, EL CAJON, CA 92020-3053
(619) 343-8167
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61514C
DENTIST
CA
Enumeration date
11/01/2021
Last updated
11/01/2021
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