Provider Demographics
NPI:1336290535
Name:PICACHE, OSCAR MERLA (DDS)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:MERLA
Last Name:PICACHE
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 1:1539 E PLAZA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3641
Mailing Address - Country:US
Mailing Address - Phone:619-474-1072
Mailing Address - Fax:619-474-4653
Practice Address - Street 1:1539 E PLAZA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3641
Practice Address - Country:US
Practice Address - Phone:619-474-1072
Practice Address - Fax:619-474-4653
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330065869OtherTAX ID