Organization
DIXON AND THURSTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ORDOUKHANIAN (OFFICE MANAGER HR DIRECTOR)
(858) 676-5000
Entity
Organization
Contact information
Practice address
11616 IBERIA PLACE, SAN DIEGO, CA 92128
(858) 676-5000
(858) 676-5016
Mailing address
11616 IBERIA PLACE, SAN DIEGO, CA 92128
(858) 676-5000
(858) 676-5016
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
173912
UNITED CONCORDIA INS
—
01
—
809272
UNITED CONCORDIA INS
—
05
—
D33462
—
CA
Enumeration date
11/29/2006
Last updated
09/11/2025
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