1831312834 NPI number — ALAN WYTHE BUDENZ DDS

Table of content: ALAN WYTHE BUDENZ DDS (NPI 1831312834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831312834 NPI number — ALAN WYTHE BUDENZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDENZ
Provider First Name:
ALAN
Provider Middle Name:
WYTHE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831312834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2155 WEBSTER ST
Provider Second Line Business Mailing Address:
UNIVERSITY OF THE PACIFIC, AAD SCHOOL OF DENTISTRY
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94115-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-929-6574
Provider Business Mailing Address Fax Number:
415-749-3339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2155 WEBSTER ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF THE PACIFIC, AAD SCHOOL OF DENTISTRY
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-929-6574
Provider Business Practice Location Address Fax Number:
415-749-3339
Provider Enumeration Date:
04/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  CA30908 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)