Healthcare Provider Details

I. General information

NPI: 1629246491
Provider Name (Legal Business Name): DALE DENIO D,D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 CARMEL COUNTRY RD SUITE 201
SAN DIEGO CA
92130-2159
US

IV. Provider business mailing address

12750 CARMEL COUNTRY ROAD SUITE 201
SAN DIEGO CA
92130-2171
US

V. Phone/Fax

Practice location:
  • Phone: 858-792-8201
  • Fax: 858-792-5163
Mailing address:
  • Phone: 858-792-8201
  • Fax: 858-792-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number34833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: