Healthcare Provider Details

I. General information

NPI: 1316105380
Provider Name (Legal Business Name): GAVIN MICHAEL UCHIDA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E CHASE AVE STE 101
EL CAJON CA
92020-6300
US

IV. Provider business mailing address

260 E CHASE AVE STE 101
EL CAJON CA
92020-6300
US

V. Phone/Fax

Practice location:
  • Phone: 415-533-1353
  • Fax:
Mailing address:
  • Phone: 415-533-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number55730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: