Organization
SAFOURA MASSOUMI PROFESSIONAL DENTAL CORP.
Active
Other names
Children's Primary Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID VELAZQUEZ (OFFICE MANAGER)
(619) 425-9930
Entity
Organization
Contact information
Practice address
397 E STREET SUITE A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Mailing address
397 E STREET SUITE A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
40677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9226502
—
CA
Enumeration date
03/07/2007
Last updated
05/27/2015
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