Healthcare Provider Details

I. General information

NPI: 1164047668
Provider Name (Legal Business Name): TODOR STAVREV DDS MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STOCKTON ST FL 3
SAN FRANCISCO CA
94108-5314
US

IV. Provider business mailing address

260 STOCKTON ST FL 3
SAN FRANCISCO CA
94108-5314
US

V. Phone/Fax

Practice location:
  • Phone: 415-399-9200
  • Fax:
Mailing address:
  • Phone: 415-399-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TODOR STAVREV
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 415-399-9200