Provider Demographics
NPI:1962928788
Name:SANTEE DENTAL CARE FOR HAPPY TEETH
Entity type:Organization
Organization Name:SANTEE DENTAL CARE FOR HAPPY TEETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-258-2670
Mailing Address - Street 1:8962 CARLTON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2932
Mailing Address - Country:US
Mailing Address - Phone:619-258-2670
Mailing Address - Fax:
Practice Address - Street 1:8962 CARLTON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2932
Practice Address - Country:US
Practice Address - Phone:619-258-2670
Practice Address - Fax:619-258-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44164261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherPPO