Organization
CHULA VISTA DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANIJEH MAROON D.D.S., F.I.C.O.I. (PRESIDENT)
(619) 409-1400
Entity
Organization
Contact information
Practice address
1177 BROADWAY STE 19, CHULA VISTA, CA 91911-2771
(619) 409-1400
Mailing address
1177 BROADWAY STE 19, CHULA VISTA, CA 91911-2771
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40946
CA
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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