Individual
ALICE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2310 CRAVEN ST, SAN DIEGO, CA 92136-4020
(619) 556-8240
Mailing address
12198 FERNCREST PL, SAN DIEGO, CA 92128-4349
(858) 442-5455
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
112159
CA
Other
Enumeration date
06/23/2023
Last updated
07/30/2025
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