MEDICARE: DENTAL PRACTICE OF JOHN PAWLAK, D.D.S., A DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1922932631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PRACTICE OF JOHN PAWLAK, D.D.S., A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	7610 HAZARD CENTER DR STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7610 HAZARD CENTER DR STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4536
Country	:	US
Telephone Number	:	619-300-9980
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	HAIFA HEATHER KISS
Credential	:
Telephone Number	:	619-300-9980

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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