Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2006-07-28
- Last updated
- 2017-04-26
Specialties
Licenses
- License CA
- 47454
Location
- Practice location
- 1620 ALPINE BLVD, #121
- City
- ALPINE CA
- Postal code
- 919011102
- Phone
- 619-445-8896
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.