Healthcare Provider Details

I. General information

NPI: 1942120332
Provider Name (Legal Business Name): GIA DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 K ST STE A
CHULA VISTA CA
91911-1209
US

IV. Provider business mailing address

355 K ST STE A
CHULA VISTA CA
91911-1209
US

V. Phone/Fax

Practice location:
  • Phone: 619-934-5713
  • Fax: 619-934-6220
Mailing address:
  • Phone: 619-934-5713
  • Fax: 619-934-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVAN R MORENO
Title or Position: DENTIST
Credential: DDS
Phone: 619-934-5713