Organization
CENTRAL COAST PEDIATRIC DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA M LIZAOLA (ADMINISTRATIVE ASSISTANT)
(831) 442-8878
Entity
Organization
Contact information
Practice address
633 E ALVIN DR STE B, SALINAS, CA 93906-3000
(831) 443-1177
(831) 443-0705
Mailing address
631 E ALVIN DRIVE, SUITE C, SALINAS, CA 93906
(831) 442-8878
(831) 443-4611
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
37400
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9087502
—
CA
Enumeration date
10/04/2006
Last updated
03/29/2021
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