Provider Demographics
NPI:1588842413
Name:NBDC SAN DIEGO
Entity Type:Organization
Organization Name:NBDC SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FOR DENTAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-556-8200
Mailing Address - Street 1:2310 CRAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-5596
Mailing Address - Country:US
Mailing Address - Phone:619-556-8200
Mailing Address - Fax:
Practice Address - Street 1:2310 CRAVEN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5596
Practice Address - Country:US
Practice Address - Phone:619-556-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental