MEDICARE: KIRK L PASQUINELLI DDS INC

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
1	1223P0300X	Periodontics	30984	CA

General Provider Information

NPI Number	:	1255798856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRK L PASQUINELLI DDS INC

Provider Business Mailing Address
First Line	:	450 SUTTER ST RM 1314
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4002
Country	:	US
Telephone Number	:	415-781-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 1314
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4002
Country	:	US
Telephone Number	:	415-781-7147
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIRK LEE PASQUINELLI
Credential	:	DDS
Telephone Number	:	415-781-7147

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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