Healthcare Provider Details

I. General information

NPI: 1194855767
Provider Name (Legal Business Name): DENTAL ADMINISTRATVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4492 CAMINO DE LA PLZ #1166
SAN YSIDRO CA
92173-3003
US

IV. Provider business mailing address

4492 CAMINO DE LA PLZ #1166
SAN YSIDRO CA
92173-3003
US

V. Phone/Fax

Practice location:
  • Phone: 619-205-4604
  • Fax:
Mailing address:
  • Phone: 619-205-4604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO FERNANDO OCHOA
Title or Position: PRESIDENT
Credential:
Phone: 619-205-4604