Healthcare Provider Details

I. General information

NPI: 1154009629
Provider Name (Legal Business Name): UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST STE 2F
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

155 5TH ST STE 23M
SAN FRANCISCO CA
94103-2919
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6675
  • Fax:
Mailing address:
  • Phone: 415-929-6501
  • Fax: 415-929-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ED PEGUEROS
Title or Position: ASST. DEAN BUDGET & FIN ADMIN
Credential:
Phone: 415-351-7192