Healthcare Provider Details

I. General information

NPI: 1699183046
Provider Name (Legal Business Name): STUDIO DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 MISSION BAY BLVD S SUITE 124
SAN FRANCISCO CA
94158-2158
US

IV. Provider business mailing address

455 MISSION BAY BLVD S SUITE 124
SAN FRANCISCO CA
94158-2158
US

V. Phone/Fax

Practice location:
  • Phone: 415-515-0450
  • Fax:
Mailing address:
  • Phone: 415-515-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LOWELL CAULDER
Title or Position: PRESIDENT
Credential:
Phone: 415-527-0263