Healthcare Provider Details

I. General information

NPI: 1639219306
Provider Name (Legal Business Name): FRANCISCO J. PESTANA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 BROADWAY ST SUITE C1-C2
AMERICAN CANYON CA
94503-1230
US

IV. Provider business mailing address

3429 BROADWAY ST SUITE C1-C2
AMERICAN CANYON CA
94503-1230
US

V. Phone/Fax

Practice location:
  • Phone: 707-980-7274
  • Fax: 707-731-1885
Mailing address:
  • Phone: 707-980-7274
  • Fax: 707-731-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number47153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: