Park Blvd Oral Surgery | |
4067 Park Blvd San Diego CA 92103-2619 | |
(619) 795-0154 | |
(619) 795-0512 |
Full Name | Park Blvd Oral Surgery |
---|---|
Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 4067 Park Blvd, San Diego, California |
Authorized Official Name and Position | Stjepan Steven Podstreleny (OWNER) |
Authorized Official Contact | 6197950154 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Park Blvd Oral Surgery 4067 Park Blvd San Diego CA 92103-2619 Ph: (619) 795-0154 | Park Blvd Oral Surgery 4067 Park Blvd San Diego CA 92103-2619 Ph: (619) 795-0154 |
NPI Number | 1023322468 |
---|---|
Provider Enumeration Date | 07/27/2010 |
Last Update Date | 07/16/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023322468 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 50861 (California) | Primary |
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