| Branch Dental Clinic Edson Range Annex | |
|
14th Street Building 13128 Camp Pendleton CA 92055 | |
| (760) 725-3213 | |
| (760) 725-8223 |
| Full Name | Branch Dental Clinic Edson Range Annex |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 14th Street, Camp Pendleton, California |
| Authorized Official Name and Position | William Michael Condon (NAVY MEDICINE UBO PROGRAM MANAGER) |
| Authorized Official Contact | 2404013643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Branch Dental Clinic Edson Range Annex Po Box 555221 Camp Pendleton CA 92055-5221 Ph: (760) 725-3213 | Branch Dental Clinic Edson Range Annex 14th Street Building 13128 Camp Pendleton CA 92055 Ph: (760) 725-3213 |
| NPI Number | 1558548008 |
|---|---|
| Provider Enumeration Date | 01/28/2008 |
| Last Update Date | 05/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558548008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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