Organization
AFAMILYFRIEND TELEDENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY PASCUA (FOUNDER)
(760) 436-3335
Entity
Organization
Contact information
Practice address
855 MARINA BAY PKWY, RICHMOND, CA 94804-6497
(707) 727-8326
Mailing address
1502 N WILLOWSPRING DR, ENCINITAS, CA 92024-5634
(760) 436-3335
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C1120725
DL
CA
01
—
E2797118
DRIVING LICENSE
CA
Enumeration date
08/11/2022
Last updated
08/31/2022
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