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NPI Code Detail

MEDICARE: HEATHER L GNAU DDS

MEDICARE: HEATHER L GNAU DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7568KY

General Provider Information

NPI Number : 1033102009
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER L GNAU DDS
Provider Business Mailing Address
First Line : 2150 CAMINO DE LA REINA
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-5517
Country : US
Telephone Number : 858-610-1242
Fax Number :
Provider Business Practice Location Address
First Line : BLDG 2495 MITSCHER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92145
Country : US
Telephone Number : 858-577-1825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 07/08/2007

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Directions to “ HEATHER L GNAU DDS” Practice Location

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