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General NPI Number Information
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NPI Number | 1225523855
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Entity Type | Organization
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Legal Business Name | CARLSBAD FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 2010 CASSIA RD STE 110
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City | CARLSBAD
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State | CA
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Zip | 92009-4210
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Country | US
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Telephone | 760-930-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N BROADWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1607
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Country | US
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Telephone | 760-922-7777
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | MICHELLE R GALLICE
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Credential |
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Telephone | 760-902-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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