1750578670 NPI number — DEARBORN & ASSOCIATES INSTITUTE FOR JOINT RESTORATION

Table of content: (NPI 1750578670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750578670 NPI number — DEARBORN & ASSOCIATES INSTITUTE FOR JOINT RESTORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARBORN & ASSOCIATES INSTITUTE FOR JOINT RESTORATION
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:
Provider Other Organization Name Type Code:
6
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:
1750578670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/19/2021
NPI Reactivation Date:
02/03/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 WELCH ROAD, SUITE 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-818-7210
Provider Business Mailing Address Fax Number:
510-794-7570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1706 EL CAMINO REAL STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENLO PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94027-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-818-7210
Provider Business Practice Location Address Fax Number:
510-794-7570
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEARBORN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-818-7210

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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