Provider Demographics
NPI:1467095547
Name:GCA ASHMORE DENTAL CORP
Entity Type:Organization
Organization Name:GCA ASHMORE DENTAL CORP
Other - Org Name:DENTAL EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-701-6629
Mailing Address - Street 1:4110 W POINT LOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5603
Mailing Address - Country:US
Mailing Address - Phone:619-701-6629
Mailing Address - Fax:
Practice Address - Street 1:1310 E VALLEY PKWY STE A
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2341
Practice Address - Country:US
Practice Address - Phone:619-701-6632
Practice Address - Fax:619-566-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty