1114006061 NPI number — UCSF FACULTY GRP DENT PRACT & GRAD PROSTHODONTICS CL3

Table of content: (NPI 1114006061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114006061 NPI number — UCSF FACULTY GRP DENT PRACT & GRAD PROSTHODONTICS CL3

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF FACULTY GRP DENT PRACT & GRAD PROSTHODONTICS CL3
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UCSF PROSTHODONTICS
Provider Other Organization Name Type Code:
5
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:
1114006061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 PARNASSUS AVE
Provider Second Line Business Mailing Address:
D4000
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-0758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-476-1784
Provider Business Mailing Address Fax Number:
415-514-3180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 PARNASSUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-0752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-502-7320
Provider Business Practice Location Address Fax Number:
415-514-3180
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DEAN, SCHOOL OF DENTISTRY
Authorized Official Telephone Number:
415-476-9135

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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