Provider Demographics
NPI:1205215613
Name:SYCAMORE DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SYCAMORE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKARIA ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-598-9654
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-0069
Mailing Address - Country:US
Mailing Address - Phone:760-598-9654
Mailing Address - Fax:760-598-9878
Practice Address - Street 1:906 SYCAMORE AVE STE 200
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7851
Practice Address - Country:US
Practice Address - Phone:760-598-9654
Practice Address - Fax:760-598-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389911223G0001X
CA392581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty