Provider Demographics
NPI:1225523855
Name:CARLSBAD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CARLSBAD FAMILY DENTISTRY
Other - Org Name:CARLSBAD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALLICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-902-9602
Mailing Address - Street 1:151 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1607
Mailing Address - Country:US
Mailing Address - Phone:760-922-7777
Mailing Address - Fax:
Practice Address - Street 1:2010 CASSIA RD STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4210
Practice Address - Country:US
Practice Address - Phone:760-930-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMTHOR DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental