Healthcare Provider Details

I. General information

NPI: 1770148728
Provider Name (Legal Business Name): CITRACADO DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W EL NORTE PKWY
ESCONDIDO CA
92026-3983
US

IV. Provider business mailing address

500 W EL NORTE PKWY
ESCONDIDO CA
92026-3983
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-5545
  • Fax: 760-489-5546
Mailing address:
  • Phone: 760-489-5545
  • Fax: 760-489-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT JUNGMAN
Title or Position: PARTNER DENTIST
Credential: DDS
Phone: 760-489-5545