MEDICARE: IMELDA HILDA DAVID DMD INC

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	122300000X	Dentist	56120	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710248208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMELDA HILDA DAVID DMD INC

Provider Business Mailing Address
First Line	:	11818 AVENIDA MARCELLA
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-4060
Country	:	US
Telephone Number	:	619-277-7728
Fax Number	:	619-660-2138

Provider Business Practice Location Address
First Line	:	5059 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3348
Country	:	US
Telephone Number	:	619-583-7720
Fax Number	:	619-583-7722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IMELDA HILDA DAVID
Credential	:	DMD
Telephone Number	:	619-583-7720

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	06/04/2012

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