Healthcare Provider Details

I. General information

NPI: 1992918650
Provider Name (Legal Business Name): TOBY BURGESS, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 WOODSIDE RD
REDWOOD CITY CA
94061-3611
US

IV. Provider business mailing address

902 WOODSIDE RD
REDWOOD CITY CA
94061-3611
US

V. Phone/Fax

Practice location:
  • Phone: 650-365-8982
  • Fax: 650-365-8928
Mailing address:
  • Phone: 650-365-8982
  • Fax: 650-365-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17247
License Number StateCA

VIII. Authorized Official

Name: DR. TOBY BURGESS
Title or Position: ORTHODONTIST
Credential: D.D.S.
Phone: 650-365-8982