Provider Demographics
NPI:1134214281
Name:ESKELAND AND ETTEFAGH DENTAL CORPORATION
Entity type:Organization
Organization Name:ESKELAND AND ETTEFAGH DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ESKELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-587-9077
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-687-9077
Mailing Address - Fax:858-587-4663
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-687-9077
Practice Address - Fax:858-587-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty