Healthcare Provider Details

I. General information

NPI: 1568642924
Provider Name (Legal Business Name): DAVID B JOSEPH A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 E MAIN ST SUITE G
EL CAJON CA
92021
US

IV. Provider business mailing address

1183 E MAIN ST SUITE G
EL CAJON CA
92021
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-2566
  • Fax: 619-441-2554
Mailing address:
  • Phone: 619-441-2566
  • Fax: 619-441-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53605
License Number StateCA

VIII. Authorized Official

Name: DAVID BENJAMINE JOSEPH
Title or Position: DR PRESIDENT
Credential: DDS
Phone: 619-441-2566