Provider Demographics
NPI:1770148728
Name:CITRACADO DENTAL GROUP
Entity type:Organization
Organization Name:CITRACADO DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-489-5545
Mailing Address - Street 1:500 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3983
Mailing Address - Country:US
Mailing Address - Phone:760-489-5545
Mailing Address - Fax:760-489-5546
Practice Address - Street 1:500 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3983
Practice Address - Country:US
Practice Address - Phone:760-489-5545
Practice Address - Fax:760-489-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265653828OtherNPPES
1841330198OtherNPPES
CA1902156367OtherNPPES
1194124867OtherNPPES
1558582247OtherNPPES
1356562821OtherNPPES