Healthcare Provider Details

I. General information

NPI: 1942122726
Provider Name (Legal Business Name): HYATT SUBIDO DENTAL GROUP, INC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 MAGNOLIA AVE
LARKSPUR CA
94939-2035
US

IV. Provider business mailing address

428 MAGNOLIA AVE
LARKSPUR CA
94939-2035
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-7900
  • Fax:
Mailing address:
  • Phone: 415-924-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW SUBIDO
Title or Position: C.E.O./PRESIDENT
Credential: D.D.S.
Phone: 415-205-2402