Healthcare Provider Details

I. General information

NPI: 1134214281
Provider Name (Legal Business Name): ESKELAND AND ETTEFAGH DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW SUITE 100
LA JOLLA CA
92037
US

IV. Provider business mailing address

4150 REGENTS PARK ROW SUITE 100
LA JOLLA CA
92037
US

V. Phone/Fax

Practice location:
  • Phone: 858-687-9077
  • Fax: 858-587-4663
Mailing address:
  • Phone: 858-687-9077
  • Fax: 858-587-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN P ESKELAND
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 858-587-9077