Healthcare Provider Details

I. General information

NPI: 1831240399
Provider Name (Legal Business Name): NANCY RUTLEY FENSTERMACHER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 TELEGRAPH AVE SUITE 303
BERKELEY CA
94705-2060
US

IV. Provider business mailing address

2915 TELEGRAPH AVE SUITE 303
BERKELEY CA
94705-2060
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-0108
  • Fax: 510-841-7314
Mailing address:
  • Phone: 510-841-0108
  • Fax: 510-841-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: