Healthcare Provider Details

I. General information

NPI: 1922932631
Provider Name (Legal Business Name): DENTAL PRACTICE OF JOHN PAWLAK, D.D.S., A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 HAZARD CENTER DR STE 701
SAN DIEGO CA
92108-4536
US

IV. Provider business mailing address

7610 HAZARD CENTER DR STE 701
SAN DIEGO CA
92108-4536
US

V. Phone/Fax

Practice location:
  • Phone: 619-300-9980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HAIFA HEATHER KISS
Title or Position: CFO
Credential:
Phone: 619-300-9980