Healthcare Provider Details

I. General information

NPI: 1689318255
Provider Name (Legal Business Name): KRISTINA ZOULAS, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 ASHBY AVE
BERKELEY CA
94705-2063
US

IV. Provider business mailing address

3550 CALLAN BLVD
SOUTH SAN FRANCISCO CA
94080-5117
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-8780
  • Fax:
Mailing address:
  • Phone: 650-873-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINA ZOULAS
Title or Position: PRESIDENT
Credential: DDS
Phone: 510-332-1982