LAJOLLA COSMETIC & FAMILY DENTISTRY INC (NPI# 1497946933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497946933 |
| Entity Type | Organization |
| Organization Name | LAJOLLA COSMETIC & FAMILY DENTISTRY INC |
| Practice Address |
470 Nautilus St # 212 La Jolla CA 92037 |
| Practice Telephone | 8584595591 |
| Practice Fax Number | 8584594242 |
| Mailing Telephone | 8584595591 |
| Mailing Fax Number | 8584594242 |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2008-05-28 |
| Authorized Official Name | NICK PAVLOV (DENTIST) |
| Authorized Official Telephone | 8584595591 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | LAJOLLA COSMETIC & FAMILY DENTISTRY INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
44055 | CA | Ambulatory Health Care Facilities |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
44055 | CA | Dental Providers |
| Street Address |
470 NAUTILUS ST # 212 |
| City | LA JOLLA |
| State | CA |
| Zip Code | 92037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861610891 | Diane Mary Bousquin | Acupuncturist | 470 Nautilus St, #201, La Jolla, CA 92037-5969 | 2007-04-23 |
| 1619160850 | Sara B Sas | Acupuncturist | 470 Nautilus St, 201, La Jolla, CA 92037-5969 | 2007-08-21 |
| 1740498526 | Miyamoto and Phi Dental Corporation | Dentist | 470 Nautilus St, Suite 309, La Jolla, CA 92037-5969 | 2007-05-18 |
| 1992913743 | Tiffany Phi | Dentist | 470 Nautilus St, Suite 309, La Jolla, CA 92037-5969 | 2007-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982221768 | Equip Health Medical, PC | Clinic/Center | 2674 Costebelle Drive, Unit A, La Jolla, CA 92037 | 2020-06-29 |
| 1134745474 | Brenda Kay Wiederhold | Psychologist | Virtual Reality Medical Center, 9834 Genesee Avenue, Suite 427, La Jolla, CA 92037 | 2020-06-23 |
| 1316581598 | Kathleen M Blechertas | Physical Therapist | 9888 Genesee, Lj19, La Jolla, CA 92037 | 2019-10-31 |
| 1316592876 | Kevin Yanyan Li | Student in an Organized Health Care Education/Training Program | 9300 Campus Point Drive, Mc7400, La Jolla, CA 92037 | 2019-08-01 |
| 1407400542 | Juan J Salmeron | Dentist | Callejin Internacional 351 L2, Los Algodones, BAJA CALIFORNIA 92037 | 2019-07-26 |
| 1609428598 | Nicole Whitney Mark | Physician Assistant | 8103 Caminito Sonoma, La Jolla, CA 92037 | 2019-07-11 |
| 1700357936 | Cecelia Rose Greene/pendzich | Mastectomy Fitter | 7760 Fay Ave, Suite M., La Jolla, CA 92037 | 2018-12-16 |
| 1740765890 | Jeenal Ankit Gordhandas | Student in an Organized Health Care Education/Training Program | East Campus Office Building, Medical Center Dr, La Jolla, CA 92037 | 2018-09-25 |
| 1306325220 | Lisa Beth Perlov Marks | Marriage & Family Therapist | 7734 Hershel Avenue, Suite O, La Jolla, CA 92037 | 2018-08-10 |
| 1023596731 | Uc San Diego, Pathology Dept | Pathology | East Campus Office Building, Medical Center Dr, San Diego, CA 92037 | 2018-08-03 |
| Find all providers in zip 92037 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578105243 | Michael L Reynolds | Dentist | 7742 Herschel Ave Ste I, La Jolla, CA 92037-4444 | 2019-10-14 |
| 1851957542 | Chad Dains Dds Inc | Dentist | 7509 Draper Ave Ste B, La Jolla, CA 92037-4857 | 2019-05-17 |
| 1104202498 | Leland Joseph Fitzgerald | Dentist | 340 Belvedere St, La Jolla, CA 92037-5307 | 2015-08-10 |
| 1962892265 | A. Simpson Miller Dental Corporation | Dentist | 888 Prospect St, Suite 200, La Jolla, CA 92037-4260 | 2015-01-26 |
| 1639591001 | Ashley Olson | Dentist | 1111 Torrey Pines Rd Ste 101, La Jolla, CA 92037-4550 | 2014-01-20 |
| 1821358474 | Jeffrey Eastman Brockett | Dentist | 7776 Ivanhoe Ave Ste 100, La Jolla, CA 92037-4575 | 2012-05-16 |
| 1609014927 | Manning Barber | Dentist | 407 Nautilus St, Ste 307, La Jolla, CA 92037 | 2009-01-23 |
| 1306096383 | Sada Hikmet Yaldo | Dentist | 5464 Soledad Rd, La Jolla, CA 92037-7042 | 2008-09-25 |
| 1730356924 | Alicia Krasuake Kennedy | Dentist | 7334 Girard Ave Ste 101, La Jolla, CA 92037-5141 | 2008-05-15 |
| 1366619553 | Jennifer Dawn Rens | Dentist | 7334 Girard Ave Ste 104, La Jolla, CA 92037-5141 | 2008-05-15 |
| Find all providers in LA JOLLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.