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NPI Code Detail

MEDICARE: UNITED DENTAL GROUP

MEDICARE: UNITED DENTAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry45218CA

General Provider Information

NPI Number : 1104033612
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED DENTAL GROUP
Provider Business Mailing Address
First Line : 1840 EL CAMINO REAL
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-3102
Country : US
Telephone Number : 650-777-9195
Fax Number : 650-777-9197
Provider Business Practice Location Address
First Line : 1840 EL CAMINO REAL
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-3102
Country : US
Telephone Number : 650-777-9195
Fax Number : 650-777-9197
Authorized Official
Title or Position : PRESIDENT
Name : DR. SHIH (MICHAEL) W. TSENG
Credential : D.D.S.
Telephone Number : 650-777-9195
Provider Enumeration Date : 05/16/2007
Last Update Date : 08/22/2020

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Directions to “UNITED DENTAL GROUP ” Practice Location

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