Healthcare Provider Details

I. General information

NPI: 1922106368
Provider Name (Legal Business Name): MISSION HILLS ENDODONTICS, A DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39572 STEVENSON PL SUITE 121
FREMONT CA
94539-3075
US

IV. Provider business mailing address

39572 STEVENSON PL SUITE 121
FREMONT CA
94539-3075
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-6600
  • Fax: 510-794-1525
Mailing address:
  • Phone: 510-794-6600
  • Fax: 510-794-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number39619
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM C CLIFF
Title or Position: GENERAL PARTNER
Credential: DDS, MSD
Phone: 510-794-6600