Healthcare Provider Details

I. General information

NPI: 1457218018
Provider Name (Legal Business Name): A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8024 LA MESA BLVD
LA MESA CA
91942-0335
US

IV. Provider business mailing address

8024 LA MESA BLVD
LA MESA CA
91942-0335
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-6166
  • Fax: 619-461-2508
Mailing address:
  • Phone: 619-461-6166
  • Fax: 619-461-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE TALBOT
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 619-461-6166