Healthcare Provider Details

I. General information

NPI: 1134837420
Provider Name (Legal Business Name): AFAMILYFRIEND TELEDENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N WILLOWSPRING DR
ENCINITAS CA
92024-5634
US

IV. Provider business mailing address

1502 N WILLOWSPRING DR
ENCINITAS CA
92024-5634
US

V. Phone/Fax

Practice location:
  • Phone: 858-663-1862
  • Fax:
Mailing address:
  • Phone: 858-663-1862
  • Fax:

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: GARY PASCUA
Title or Position: FOUNDER
Credential:
Phone: 858-663-1862