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General NPI Number Information
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NPI Number | 1366877953
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Entity Type | Organization
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Legal Business Name | PHILIP G. MENNA
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 4002 PARK BLVD STE D
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City | SAN DIEGO
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State | CA
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Zip | 92103-2600
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Country | US
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Telephone | 619-220-7000
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Fax | 619-220-7010
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Provider Business Mailing Address
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Address Line | PO BOX 33838
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City | SAN DIEGO
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State | CA
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Zip | 92163-3838
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Country | US
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Telephone | 619-220-7000
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Fax | 619-220-7010
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PHILIP G MENNA
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Credential | D.D.S.
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Telephone | 619-220-7000
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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 | 21613
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License Number State | CA
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