Provider Demographics
NPI:1023216751
Name:SAN DIEGO SPECIALTY CARE
Entity Type:Organization
Organization Name:SAN DIEGO SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-293-3352
Mailing Address - Street 1:5638 MISSION CENTER RD
Mailing Address - Street 2:#105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4348
Mailing Address - Country:US
Mailing Address - Phone:619-293-3352
Mailing Address - Fax:619-293-0708
Practice Address - Street 1:5638 MISSION CENTER RD
Practice Address - Street 2:#105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4348
Practice Address - Country:US
Practice Address - Phone:619-293-3352
Practice Address - Fax:619-293-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238561223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty