Provider Demographics
NPI:1629246491
Name:DENIO, DALE (D,DS, MS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:DENIO
Suffix:
Gender:M
Credentials:D,DS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 CARMEL COUNTRY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2171
Mailing Address - Country:US
Mailing Address - Phone:858-792-8201
Mailing Address - Fax:858-792-5163
Practice Address - Street 1:12750 CARMEL COUNTRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2159
Practice Address - Country:US
Practice Address - Phone:858-792-8201
Practice Address - Fax:858-792-5163
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics