Healthcare Provider Details

I. General information

NPI: 1720097413
Provider Name (Legal Business Name): ANA JOSEFINA AMAYA DDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1589
US

IV. Provider business mailing address

905 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1589
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-0343
  • Fax: 415-457-8366
Mailing address:
  • Phone: 415-457-0343
  • Fax: 415-457-8366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number44563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: