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General NPI Number Information
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NPI Number | 1720720469
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Entity Type | Organization
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Legal Business Name | SAN DIEGO COUNTY DENTAL FOUNDATION
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 3670 COUTS ST
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City | SAN DIEGO
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State | CA
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Zip | 92110-2085
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Country | US
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Telephone | 619-275-7188
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Fax |
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Provider Business Mailing Address
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Address Line | 3670 COUTS ST
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City | SAN DIEGO
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State | CA
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Zip | 92110-2085
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Country | US
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Telephone | 619-275-7188
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THOMAS J ZANE JR.
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Credential |
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Telephone | 619-840-8718
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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