| NPI | 1023552197 |
|---|---|
| Doing Business As | UNIVERSITY AVENUE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | PATTI THERRIAULT Office Manager 619-582-4224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.030207) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |