Organization
GARY AND MARY WEST SENIOR DENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN BECERRA DDS, MPH (PRESIDENT AND DENTIST)
(760) 602-5862
Entity
Organization
Contact information
Practice address
1525 4TH AVE, SAN DIEGO, CA 92101-3107
(760) 602-5862
Mailing address
1525 4TH AVE, SAN DIEGO, CA 92101-3107
(760) 602-5862
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
55692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740451012
INDIVIDUAL DENTAL PROVIDER NPI
CA
Enumeration date
08/11/2015
Last updated
08/11/2015
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