Organization · NPI-2

4030 Dental INC.

Dentist · San Diego, CA

NPI number1275833956
StatusActive
Last updated in NPPESOct 27, 2010

Details

NPI
1275833956
Entity type
Organization (NPI-2)
Legal business name
4030 Dental INC.
Organization subpart
No
Enumeration date
Oct 27, 2010
Last updated
Oct 27, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

6175 El Cajon Blvd
San Diego, CA 92115-3915

Phone 630-567-6373

Mailing address

6175 El Cajon Blvd
San Diego, CA 92115-3915

Phone 619-583-4030

Authorized official

Rawaa Aldairi
President
6305676373

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