Organization
T SIDAL DDS MD INC
Active
Other names
TORREY PINES ORAL AND MAXILLOFACIAL SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARKAN SIDAL DDS,MD (PRESIDENT)
(312) 505-8656
Entity
Organization
Contact information
Practice address
12395 EL CAMINO REAL, SUITE 304, TORREY PINES ORAL & MAXILLOFACIAL SURGERY, SAN DIEGO, CA 92130
(858) 793-3393
Mailing address
12395 EL CAMINO REAL, SUITE 304, TORREY PINES ORAL & MAXILLOFACIAL SURGERY, SAN DIEGO, CA 92130
(858) 793-3393
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
OMS 101
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
A122601
CA
Other
Enumeration date
06/25/2015
Last updated
06/26/2015
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