Organization
TOLOSA CHILDRENS DENTAL CENTER
Active
Parent organization
TOLOSA CHILDREN'S DENTAL CENTER
Other names
Tolosa Childrens Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
TOLOSA CHILDREN'S DENTAL CENTER
Authorized official
SUZANNE RUSSELL (CLINIC DIRECTOR)
(805) 238-2216
Entity
Organization
Contact information
Practice address
4251 S HIGUERA ST STE 401, SAN LUIS OBISPO, CA 93401-7714
(805) 238-2216
(805) 238-6470
Mailing address
717 WALNUT DR, PASO ROBLES, CA 93446-2315
(805) 238-5334
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D50253
CA
Other
Enumeration date
10/15/2014
Last updated
07/02/2019
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