OrganizationRancho San Diego DentalDentistDental ProvidersPractice Address2648 Jamacha Rd, Suite 166, El Cajon, CA 92019-4346(619) 670-5571PECOS EnrollmentBased on the most recent information from CMS, provider Rancho San Diego Dental does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1639275621Provider TypeOrganizationFull NameRancho San Diego DentalSubpartNoEnumeration Date9/16/2006Last Updated3/15/2012Contact InformationPractice LocationPractice Address2648 Jamacha Rd, Suite 166, El Cajon, CA 92019-4346Phone(619) 670-5571Fax(619) 670-5592Mailing LocationMailing Address2648 Jamacha Rd, Suite 166, El Cajon, CA 92019-4346Phone(619) 670-5571Fax(619) 670-5592Authorized OfficialNameWeiner, Gerald P. (Owner)Phone(619) 670-5571Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense26243California