Organization
SD DELL DENTAL CORPORATION
Active
Other names
LA DENTAL BRACES SAN DIEGO
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA WOLFF (SUPERVISOR)
(619) 287-8870
Entity
Organization
Contact information
Practice address
6699 ALVARADO RD STE 2202, SAN DIEGO, CA 92120-5293
(619) 287-8870
Mailing address
6699 ALVARADO RD STE 2202, SAN DIEGO, CA 92120-5293
(619) 287-8870
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760666705
DENTIST
CA
Enumeration date
09/05/2023
Last updated
09/05/2023
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