Provider Demographics
NPI:1447322383
Name:OCEANSIDE DENTAL GROUP
Entity type:Organization
Organization Name:OCEANSIDE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TADANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-722-0144
Mailing Address - Street 1:709 SEAGAZE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054
Mailing Address - Country:US
Mailing Address - Phone:760-722-0144
Mailing Address - Fax:760-722-5078
Practice Address - Street 1:709 SEAGAZE DRIVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-722-0144
Practice Address - Fax:760-722-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty