| University Avenue Dental Group | |
|
6324 University Ave San Diego CA 92115-5813 | |
| (619) 582-4224 | |
| Not Available |
| Full Name | University Avenue Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 6324 University Ave, San Diego, California |
| Authorized Official Name and Position | Patti Therriault (OFFICE MANAGER) |
| Authorized Official Contact | 6195824224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Avenue Dental Group 6324 University Ave San Diego CA 92115-5813 Ph: (619) 582-4224 | University Avenue Dental Group 6324 University Ave San Diego CA 92115-5813 Ph: (619) 582-4224 |
| NPI Number | 1023552197 |
|---|---|
| Provider Enumeration Date | 12/08/2016 |
| Last Update Date | 12/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023552197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019.030207 (Illinois) | Primary |
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