Healthcare Provider Details

I. General information

NPI: 1467095547
Provider Name (Legal Business Name): GCA ASHMORE DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 09/30/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E VALLEY PKWY STE A
ESCONDIDO CA
92027-2341
US

IV. Provider business mailing address

4110 W POINT LOMA BLVD
SAN DIEGO CA
92110-5603
US

V. Phone/Fax

Practice location:
  • Phone: 619-701-6632
  • Fax: 619-566-4810
Mailing address:
  • Phone: 619-701-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN C ASHMORE
Title or Position: OWNER
Credential: DDS
Phone: 619-701-6629