Mira Mesa Dental Care
LBN: New Image Dentistry
Mira Mesa Dental Care is an health care organization with primary practice located at 819 D Avenue, Suite 101 , National City CA 91950-3465. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Managed Care Organizations / Preferred Provider Organization. Dental Providers / General Practice is the primary health care specialty.
New Image Dentistry can be contacted via phone (619) 470-2558, or through Alfonso, Rossana Tabal via phone (619) 470-2558.
Contact Information
Primary practice address
819 D Avenue, Suite 101
National City CA 91950-3465
Phone: (619) 470-2558
Fax: (619) 475-0799
Website:
Authorized official contact:
Name: Alfonso, Rossana Tabal Doctor of Dental Surgery (DDS)
Phone: (619) 470-2558
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | ||
| Managed Care Organizations / Preferred Provider Organization | 305R00000X | 49220 | California |
Profile Details
| NPI number | 1952647208 |
|---|---|
| LBN Legal business name | New Image Dentistry |
| DBA Doing business as | Mira Mesa Dental Care |
| Authorized official | Alfonso, Rossana Tabal Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Dec 13th, 2012 |
| Last updated | Jun 17th, 2016 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952647208 | NPPES |
| California | Other | 1013114156 | INDIVIDUAL NPI |
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