Healthcare Provider Details

I. General information

NPI: 1568690824
Provider Name (Legal Business Name): BRIAN MARC ASSAEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459A ASHBY AVE
BERKELEY CA
94705
US

IV. Provider business mailing address

2459A ASHBY AVE
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-9796
  • Fax: 510-948-9805
Mailing address:
  • Phone: 510-848-9796
  • Fax: 510-948-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: