Provider Demographics
NPI:1366877953
Name:PHILIP G. MENNA
Entity type:Organization
Organization Name:PHILIP G. MENNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:MENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-220-7000
Mailing Address - Street 1:PO BOX 33838
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3838
Mailing Address - Country:US
Mailing Address - Phone:619-220-7000
Mailing Address - Fax:619-220-7010
Practice Address - Street 1:4002 PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2600
Practice Address - Country:US
Practice Address - Phone:619-220-7000
Practice Address - Fax:619-220-7010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILIP G. MENNA, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty