Organization
A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE TALBOT (INSURANCE COORDINATOR)
(619) 461-6166
Entity
Organization
Contact information
Practice address
8024 LA MESA BLVD, LA MESA, CA 91942-0335
(619) 461-6166
(619) 461-2508
Mailing address
8024 LA MESA BLVD, LA MESA, CA 91942-0335
(619) 461-6166
(619) 461-2508
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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