Provider Demographics
NPI:1659374304
Name:HOWARD P. DAMBROSE, D.D.S., INC.
Entity Type:Organization
Organization Name:HOWARD P. DAMBROSE, D.D.S., INC.
Other - Org Name:DEPENDENTS DENTAL CENTER OF HOWARD P. DAMBROSE, DDS, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:DAMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-278-6444
Mailing Address - Street 1:10715 TIERRASANTA BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2610
Mailing Address - Country:US
Mailing Address - Phone:858-278-6444
Mailing Address - Fax:858-279-6444
Practice Address - Street 1:10715 TIERRASANTA BLVD
Practice Address - Street 2:STE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2610
Practice Address - Country:US
Practice Address - Phone:858-278-6444
Practice Address - Fax:858-279-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000753449OtherTRICARE-TDP (UCCI)
CA37409OtherDELTA DENTAL
CA37409OtherINSURANCE CARRIERS
CAB37409-01OtherDENTI-CAL
CA37409OtherINSURANCE CARRIERS