MEDICARE: DAS DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	122300000X	Dentist	MX
2	1223G0001X	General Practice Dentistry	MX
3	1223E0200X	Endodontics	MX
4	1223P0221X	Pediatric Dentistry	MX
5	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	MX
6	126800000X	Dental Assistant	MX
7	124Q00000X	Dental Hygienist	MX

General Provider Information

NPI Number	:	1700833993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAS DENTAL GROUP

Provider Business Mailing Address
First Line	:	4492 CAMINO DE LA PLZ
Second Line	:	SUITE 1166
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-3003
Country	:	US
Telephone Number	:	619-205-4604
Fax Number	:

Provider Business Practice Location Address
First Line	:	NETZAHUALCOYOTL #1211
Second Line	:	SUITE #1 PB
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22415
Country	:	MX
Telephone Number	:	664-683-5027
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERNESTO FERNANDO OCHOA
Credential	:
Telephone Number	:	619-205-4604

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	09/11/2025

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Directions to “DAS DENTAL GROUP ” Practice Location

Language	Start Address	Practice Location

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