Healthcare Provider Details

I. General information

NPI: 1487675179
Provider Name (Legal Business Name): HILLCREST ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WALNUT AVE SUITE 33
SAN DIEGO CA
92103-4978
US

IV. Provider business mailing address

306 WALNUT AVE SUITE 33
SAN DIEGO CA
92103-4978
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-3456
  • Fax:
Mailing address:
  • Phone: 619-295-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateCA

VIII. Authorized Official

Name: JO ANNA SAVAGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-295-3456