Healthcare Provider Details

I. General information

NPI: 1912523234
Provider Name (Legal Business Name): SANNA CHARLIE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FENTON ST STE 10
LIVERMORE CA
94550-4148
US

IV. Provider business mailing address

PO BOX 2812
DUBLIN CA
94568-0812
US

V. Phone/Fax

Practice location:
  • Phone: 925-447-8635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANNA CHARLIE
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 925-895-5268