Healthcare Provider Details

I. General information

NPI: 1487020194
Provider Name (Legal Business Name): BAY AREA DENTAL IMPLANT CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 MORAGA RD SUITE 11
LAFAYETTE CA
94549-5094
US

IV. Provider business mailing address

6161 MARGARIDO DR
OAKLAND CA
94618-1838
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-0313
  • Fax: 925-283-6818
Mailing address:
  • Phone: 925-283-0313
  • Fax: 925-283-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number53063
License Number StateCA

VIII. Authorized Official

Name: ANDREW FERRIER
Title or Position: PRESIDENT
Credential: DDS
Phone: 925-283-0313