EASTLAKE PERIODONTICS AND IMPLANTS – NPI #1376738062
Clinic/Center

EASTLAKE PERIODONTICS AND IMPLANTS is an AHC clinic located in CHULA VISTA, CA. NPPES has assigned the NPI number 1376738062 to EASTLAKE PERIODONTICS AND IMPLANTS on September 06, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “EASTLAKE PERIODONTICS AND IMPLANTS” is a dba name, the actual legal business name for this organization is COURTNEY L. STAADECKER, DDS, MS AND SCOTT T. OZAKI, DDS, INC.. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EASTLAKE PERIODONTICS AND IMPLANTS below.

NPI Profile for
COURTNEY L. STAADECKER, DDS, MS AND SCOTT T. OZAKI, DDS, INC.

NPI Number
1376738062
Enumeration Date

(about 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
COURTNEY L. STAADECKER, DDS, MS AND SCOTT T. OZAKI, DDS, INC.
Doing Business As (dba): EASTLAKE PERIODONTICS AND IMPLANTS
Primary location
2452 FENTON ST
SUITE 302
CHULA VISTA, CA 91914-3516
Phone: (619) 482-3205 Fax: (619) 482-3206
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
SCOTT OZAKI
OWNER
Phone: (619) 482-3205
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 CA 41977

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.