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General NPI Number Information
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NPI Number | 1477695401
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Entity Type | Organization
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Legal Business Name | PEARL DENTAL GROUP
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 771 E VISTA WAY STE 101
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City | VISTA
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State | CA
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Zip | 92084
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Country | US
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Telephone | 760-560-0600
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Fax | 760-560-0602
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Provider Business Mailing Address
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Address Line | 771 E VISTA WAY STE 101
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City | VISTA
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State | CA
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Zip | 92084
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Country | US
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Telephone | 760-560-0600
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Fax | 760-560-0602
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHRAF M OKBA
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Credential | DDS
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Telephone | 760-560-0600
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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 | 45944
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License Number State | CA
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