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General NPI Number Information
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NPI Number | 1205215613
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Entity Type | Organization
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Legal Business Name | SYCAMORE DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 906 SYCAMORE AVE STE 200
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City | VISTA
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State | CA
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Zip | 92081-7851
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Country | US
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Telephone | 760-598-9654
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Fax | 760-598-9878
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | VISTA
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State | CA
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Zip | 92085-0069
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Country | US
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Telephone | 760-598-9654
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Fax | 760-598-9878
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | GITA SARKARIA ENGLERT
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Credential | DDS
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Telephone | 760-598-9654
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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 | 39258
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38991
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License Number State | CA
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