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 |