Provider Demographics
NPI:1114183308
Name:HEMESATH, CARL JOESPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOESPH
Last Name:HEMESATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 3RD AVE
Mailing Address - Street 2:SUITE 3330
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1354
Mailing Address - Country:US
Mailing Address - Phone:619-422-5365
Mailing Address - Fax:619-422-3791
Practice Address - Street 1:855 3RD AVE
Practice Address - Street 2:SUITE 3330
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1354
Practice Address - Country:US
Practice Address - Phone:619-422-5365
Practice Address - Fax:619-422-3791
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16919122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist