Provider Demographics
NPI:1831414200
Name:MIGUEL GRILLO, DMD
Entity type:Organization
Organization Name:MIGUEL GRILLO, DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-755-9810
Mailing Address - Street 1:12264 EL CAMINO REAL STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3062
Mailing Address - Country:US
Mailing Address - Phone:858-755-9810
Mailing Address - Fax:858-755-9813
Practice Address - Street 1:12264 EL CAMINO REAL STE 306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3062
Practice Address - Country:US
Practice Address - Phone:858-755-9810
Practice Address - Fax:858-755-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty