Provider Demographics
NPI:1437856770
Name:ENGLUND DENTAL CORP
Entity Type:Organization
Organization Name:ENGLUND DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:ENGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-919-7348
Mailing Address - Street 1:5011 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3011
Mailing Address - Country:US
Mailing Address - Phone:206-919-7348
Mailing Address - Fax:
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR STE 202
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1480
Practice Address - Country:US
Practice Address - Phone:206-919-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty