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General NPI Number Information
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NPI Number | 1235655788
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Entity Type | Organization
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Legal Business Name | HOSS/KERI KM DENTAL GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9737 AERO DRIVE STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-636-2665
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Fax |
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Provider Business Mailing Address
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Address Line | 9737 AERO DR STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92123-1854
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Country | US
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Telephone | 619-636-2665
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAURA FLORES
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Credential |
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Telephone | 619-961-9867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 42542
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License Number State | CA
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