MEDICARE: MI LA 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
1	1223G0001X	General Practice Dentistry	109241	CA

General Provider Information

NPI Number	:	1033990759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI LA DDS

Provider Business Mailing Address
First Line	:	621 S 65TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-5712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6965 BROADWAY
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1405
Country	:	US
Telephone Number	:	619-589-0777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	12/05/2023

Similar Medicare Providers

1427253202 — DR. ANH N TRAN DDS
Practice Location Address:

6965 BROADWAY
LEMON GROVE, CA
91945-1405

Practice Phone: 619-589-0777
Practice Fax: 619-589-0722

1336406370 — ANH N TRAN DENTAL CORP
Practice Location Address:

6965 BROADWAY
LEMON GROVE, CA
91945-1405

Practice Phone: 480-735-8839
Practice Fax:

1871527713 — BRIGHT LIGHT MEDICAL IMAGING, SC
Practice Location Address:

31 S ARLINGTON HEIGHTS RD
ELK GROVE VILLAGE, IL
60007-1405

Practice Phone: 847-439-2315
Practice Fax: 847-439-3935

1275674210 — MRS. KAREN ANNE SOTTO L.M.T.
Practice Location Address:

2313 A ST
FOREST GROVE, OR
97116-1405

Practice Phone: 503-359-7857
Practice Fax:

1114055415 — SUSAN POLOMSKI MS,RD,CDE
Practice Location Address:

1405 GROVE RD , SUITE B
GREENVILLE, SC
29605-4785

Practice Phone: 865-295-3223
Practice Fax: 865-295-3244

1881811305 — JENNIFER CHIU CCP
Practice Location Address:

1405 OAK GROVE AVE , APT. 306
BURLINGAME, CA
94010-3775

Practice Phone: 650-815-1921
Practice Fax: 650-615-9995

Directions to “ MI LA DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.