Healthcare Provider Details

I. General information

NPI: 1639398712
Provider Name (Legal Business Name): TORREY DEL MAR DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13859 CARMEL VALLEY RD STE D
SAN DIEGO CA
92130-5665
US

IV. Provider business mailing address

13859 CARMEL VALLEY RD STE D
SAN DIEGO CA
92130-5665
US

V. Phone/Fax

Practice location:
  • Phone: 858-484-9090
  • Fax: 858-484-9211
Mailing address:
  • Phone: 858-484-9090
  • Fax: 858-484-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37157
License Number StateCA

VIII. Authorized Official

Name: DR. JACK ALAN ROSENSON
Title or Position: DENTIST
Credential: D.M.D.
Phone: 858-484-9090