Provider Demographics
NPI:1275726325
Name:PACIFIC DENTAL GROUP OF EL CAJON
Entity Type:Organization
Organization Name:PACIFIC DENTAL GROUP OF EL CAJON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVAN
Authorized Official - Middle Name:DJURO
Authorized Official - Last Name:PLAMENAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-447-3100
Mailing Address - Street 1:865 JACKMAN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3052
Mailing Address - Country:US
Mailing Address - Phone:619-447-3100
Mailing Address - Fax:619-447-3107
Practice Address - Street 1:865 JACKMAN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3052
Practice Address - Country:US
Practice Address - Phone:619-447-3100
Practice Address - Fax:619-447-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2611261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26111OtherRENDERING