Healthcare Provider Details

I. General information

NPI: 1720978570
Provider Name (Legal Business Name): EL CAJON DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 EUCLID AVE
SAN DIEGO CA
92115-4942
US

IV. Provider business mailing address

4309 EUCLID AVE
SAN DIEGO CA
92115-4942
US

V. Phone/Fax

Practice location:
  • Phone: 619-709-6763
  • Fax:
Mailing address:
  • Phone: 619-709-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANGEL TORRES
Title or Position: OWNER
Credential:
Phone: 619-709-6763