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General NPI Number Information
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NPI Number | 1962928788
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Entity Type | Organization
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Legal Business Name | SANTEE DENTAL CARE FOR HAPPY TEETH
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 8962 CARLTON HILLS BLVD
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City | SANTEE
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State | CA
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Zip | 92071-2932
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Country | US
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Telephone | 619-258-2670
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Fax | 619-258-2671
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Provider Business Mailing Address
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Address Line | 8962 CARLTON HILLS BLVD
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City | SANTEE
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State | CA
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Zip | 92071-2932
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Country | US
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Telephone | 619-258-2670
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LILIAN Z DOMINGUEZ
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Credential | DDS
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Telephone | 619-258-2670
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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 | 44164
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License Number State | CA
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