| Boutique Orthodontics | |
|
7855 Fay Ave Ste 220 La Jolla CA 92037-4267 | |
| (858) 454-7111 | |
| Not Available |
| Full Name | Boutique Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 7855 Fay Ave Ste 220, La Jolla, California |
| Authorized Official Name and Position | Jose Castillo (PRESIDENT) |
| Authorized Official Contact | 8584547111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boutique Orthodontics 7855 Fay Ave Ste 220 La Jolla CA 92037-4267 | Boutique Orthodontics 7855 Fay Ave Ste 220 La Jolla CA 92037-4267 Ph: (858) 454-7111 |
| NPI Number | 1992501183 |
|---|---|
| Provider Enumeration Date | 02/20/2025 |
| Last Update Date | 02/20/2025 |
| Certification Date | 02/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992501183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | () | Primary |
| 261QD0000X | Clinic/center - Dental | () | Secondary |
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