Healthcare Provider Details

I. General information

NPI: 1306111976
Provider Name (Legal Business Name): HENRIOD & MESERKHANI DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 JAMACHA RD SUITE 166
EL CAJON CA
92019-4346
US

IV. Provider business mailing address

2648 JAMACHA RD SUITE 166
EL CAJON CA
92019-4346
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-5571
  • Fax: 619-670-5592
Mailing address:
  • Phone: 619-670-5571
  • Fax: 619-670-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number55124
License Number StateCA

VIII. Authorized Official

Name: DR. JOEL B. HENRIOD
Title or Position: OWNER/PARTNERSHIP
Credential: DDS
Phone: 619-670-5571