Healthcare Provider Details

I. General information

NPI: 1669043618
Provider Name (Legal Business Name): AFFORDABLE CROWNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ADAMS AVE STE 209
SAN DIEGO CA
92116-1367
US

IV. Provider business mailing address

2700 ADAMS AVE STE 209
SAN DIEGO CA
92116-1367
US

V. Phone/Fax

Practice location:
  • Phone: 619-917-7766
  • Fax:
Mailing address:
  • Phone: 619-647-4459
  • Fax: 619-773-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK L MOSS
Title or Position: DENTIST
Credential: DDS
Phone: 619-647-4459