Organization
FABRIEL D BURQUEZ
Active
Other names
FABRIEL D BURQUEZ DDS INC
Organization subpart
No
Provider details
NPI number
Authorized official
FABRIEL DARIO BURQUEZ DDS (DENTIST)
(619) 479-4457
Entity
Organization
Contact information
Practice address
180 OTAY LAKES RD STE 210B, BONITA, CA 91902-2400
(619) 479-4457
(619) 479-4827
Mailing address
180 OTAY LAKES RD STE 210B, BONITA, CA 91902-2400
(619) 479-4457
(619) 479-4827
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
49476
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G89774-01
DENTICAL
CA
Enumeration date
10/15/2007
Last updated
10/15/2007
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