Provider Demographics
NPI:1992301048
Name:OVIEDO, MARIANO ALFREDO (DDS)
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:ALFREDO
Last Name:OVIEDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 VIA MALLORCA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2949
Mailing Address - Country:US
Mailing Address - Phone:858-522-0605
Mailing Address - Fax:
Practice Address - Street 1:202 MILE OF CARS WAY
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6605
Practice Address - Country:US
Practice Address - Phone:619-477-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice