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General NPI Number Information
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NPI Number | 1063995975
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Entity Type | Individual
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Provider Name | SEENA GHETMIRI DDS
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Gender | Male
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 8657 VILLA LA JOLLA DR STE 211
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City | LA JOLLA
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State | CA
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Zip | 92037-8309
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Country | US
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Telephone | 858-272-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W HARBOR DR UNIT 301
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City | SAN DIEGO
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State | CA
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Zip | 92101-7754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103070
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License Number State | CA
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