Healthcare Provider Details

I. General information

NPI: 1518106830
Provider Name (Legal Business Name): SUSAN CALIRI DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 DWIGHT WAY
BERKELEY CA
94710-2424
US

IV. Provider business mailing address

851 DWIGHT WAY
BERKELEY CA
94710-2424
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-2864
  • Fax: 510-845-1920
Mailing address:
  • Phone: 510-845-2864
  • Fax: 510-845-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33731
License Number StateCA

VIII. Authorized Official

Name: SUSAN CALIRI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 510-845-2864