Healthcare Provider Details

I. General information

NPI: 1215047469
Provider Name (Legal Business Name): HAROLD J GULBRANSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE #460
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR SUITE #460
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-3773
  • Fax: 619-463-1272
Mailing address:
  • Phone: 619-463-3773
  • Fax: 619-463-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number29287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: