Healthcare Provider Details

I. General information

NPI: 1770237521
Provider Name (Legal Business Name): SBPDG ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 FENTON ST STE 102
CHULA VISTA CA
91914-3522
US

IV. Provider business mailing address

2446 FENTON ST STE 102
CHULA VISTA CA
91914-3522
US

V. Phone/Fax

Practice location:
  • Phone: 619-216-1100
  • Fax: 619-216-1127
Mailing address:
  • Phone: 619-216-1100
  • Fax: 619-216-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DINO DEL FIERRO
Title or Position: GENERAL PARTNER
Credential: DDS
Phone: 619-216-1100