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1950 Shadowridge Drive Suite A Vista CA 92083 | |
| (760) 598-1707 | |
| (760) 598-2907 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1950 Shadowridge Drive, Vista, California |
| Authorized Official Name and Position | Jerrold Alan Hennes (ORTHODONTIST) |
| Authorized Official Contact | 7605981707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1950 Shadowridge Drive Suite A Vista CA 92083 Ph: (760) 598-1707 | 1950 Shadowridge Drive Suite A Vista CA 92083 Ph: (760) 598-1707 |
| NPI Number | 1770646317 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770646317 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DI34494 (California) | Primary |
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