Healthcare Provider Details

I. General information

NPI: 1952533473
Provider Name (Legal Business Name): DAVID VAKNIN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 38TH AVE
SAN FRANCISCO CA
94116-2142
US

IV. Provider business mailing address

2375 38TH AVE
SAN FRANCISCO CA
94116-2142
US

V. Phone/Fax

Practice location:
  • Phone: 415-823-4739
  • Fax:
Mailing address:
  • Phone: 415-823-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number58689
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58689
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number054922-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number00558699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: