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General NPI Number Information
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NPI Number | 1417685041
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Entity Type | Organization
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Legal Business Name | AFAMILYFRIEND TELEDENTISTRY
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 855 MARINA BAY PKWY
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City | RICHMOND
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State | CA
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Zip | 94804-6497
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Country | US
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Telephone | 707-727-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 N WILLOWSPRING DR
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City | ENCINITAS
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State | CA
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Zip | 92024-5634
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Country | US
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Telephone | 760-436-3335
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | GARY PASCUA
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Credential |
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Telephone | 760-436-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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