San Diego Dental Health Center LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

SAN DIEGO DENTAL HEALTH CENTER LLC

Practice address

9350 Campus Point Dr
La Jolla, CA 92037-1300

Phone

(310) 307-6623

NPI assigned

Nov 12, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katya ArchambaultNPI 1700350485

Title

Owner

Phone

(310) 307-6623

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katya Archambault, DMD

  • Oral and Maxillofacial Radiology Dentistry
  • La Jolla, CA
  • NPI 1700350485
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1386289478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9350 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9350 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300",
            "telephone_number": "310-307-6623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO DENTAL HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-12",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "ARCHAMBAULT",
        "authorized_official_first_name": "KATYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-307-6623"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Oral and Maxillofacial Surgery Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.