| NPI | 1952714149 |
|---|---|
| Doing Business As | LA COSTA DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | OMER ANISSO Owner 760-436-2452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 54467) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-02-09 |