Healthcare Provider Details

I. General information

NPI: 1851497630
Provider Name (Legal Business Name): AMIT BATHEJA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8018 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1615
US

IV. Provider business mailing address

8018 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1615
US

V. Phone/Fax

Practice location:
  • Phone: 858-636-7887
  • Fax:
Mailing address:
  • Phone: 858-636-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number50440
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: