Healthcare Provider Details

I. General information

NPI: 1649626490
Provider Name (Legal Business Name): VALERI SACKNOFF D D S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD STE 110
POWAY CA
92064-2068
US

IV. Provider business mailing address

15725 POMERADO RD STE 110
POWAY CA
92064-2068
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-6900
  • Fax: 858-485-5875
Mailing address:
  • Phone: 858-485-6900
  • Fax: 858-485-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34896
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number34896
License Number StateCA

VIII. Authorized Official

Name: VALERI SACKNOFF
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 858-485-6900