MEDICARE: DENTISTS OF LEMON GROVE

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

General Provider Information

NPI Number	:	1235073024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF LEMON GROVE

Provider Business Mailing Address
First Line	:	6965 BROADWAY
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1405
Country	:	US
Telephone Number	:	619-589-0777
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	:	PARTNER
Name	:	HAZZAA YAHYA
Credential	:	DMD
Telephone Number	:	619-589-0777

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “DENTISTS OF LEMON GROVE ” Practice Location

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