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General NPI Number Information
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NPI Number | 1932553633
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Entity Type | Organization
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Legal Business Name | KERI KM DENTAL GROUP, A PROFESSIONAL GROUP
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 9737 AERO DR STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92123-1859
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Country | US
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Telephone | 619-585-8500
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Fax | 619-362-9923
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Provider Business Mailing Address
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Address Line | 9737 AERO DR STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92123-1859
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Country | US
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Telephone | 619-585-8500
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Fax | 619-362-9923
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LAURA ELENA FLORES
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Credential |
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Telephone | 619-869-1149
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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 | 42542
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License Number State | CA
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