Healthcare Provider Details

I. General information

NPI: 1982955720
Provider Name (Legal Business Name): GOLDEN GATE DENTAL GROUP PRACTICE OF INESSA SOSIS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 FULTON ST
SAN FRANCISCO CA
94118-3713
US

IV. Provider business mailing address

3200 FULTON ST
SAN FRANCISCO CA
94118-3713
US

V. Phone/Fax

Practice location:
  • Phone: 415-516-3859
  • Fax:
Mailing address:
  • Phone: 415-516-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45199
License Number StateCA

VIII. Authorized Official

Name: DR. INESSA SOSIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 415-516-3859