Healthcare Provider Details

I. General information

NPI: 1396194098
Provider Name (Legal Business Name): BUENO AND SELLICK DENTISTRY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 WILLOW RD SUITE H
PLEASANTON CA
94588-8575
US

IV. Provider business mailing address

4430 WILLOW RD SUITE H
PLEASANTON CA
94588-8575
US

V. Phone/Fax

Practice location:
  • Phone: 925-426-1300
  • Fax:
Mailing address:
  • Phone: 925-426-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38498
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY BUENO
Title or Position: MANAGING PARTNER
Credential: D.D.S.
Phone: 925-426-1300