Healthcare Provider Details

I. General information

NPI: 1942869961
Provider Name (Legal Business Name): UCSF SCHOOL OF DENTISTRY CLINIC NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE # D-2000
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

707 PARNASSUS AVENUE D1130 BOX 0752
SAN FRANCISCO CA
94143-2210
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5747
  • Fax: 415-476-6110
Mailing address:
  • Phone: 415-476-5747
  • Fax: 415-476-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL REDDY
Title or Position: DEAN, SCHOOL OF DENTISTRY
Credential: DMD, DMSC
Phone: 415-476-1323