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General NPI Number Information
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NPI Number | 1346626066
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Entity Type | Organization
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Legal Business Name | KOKA DENTAL CORPORATION
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 8031 LINDA VISTA RD SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92111-5110
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Country | US
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Telephone | 858-268-5020
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Fax | 858-268-5030
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Provider Business Mailing Address
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Address Line | 8031 LINDA VISTA RD SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92111-5110
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Country | US
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Telephone | 858-268-5020
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Fax | 858-268-5030
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Authorized Official
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Title or Position | OWNER
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Name | DR. SREENIVAS KOKA
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Credential | DDS, PHD
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Telephone | 858-268-5020
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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 | 63470
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License Number State | CA
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