Healthcare Provider Details

I. General information

NPI: 1609263425
Provider Name (Legal Business Name): MKT DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 STOCKTON ST
SAN FRANCISCO CA
94108-1608
US

IV. Provider business mailing address

908 STOCKTON ST
SAN FRANCISCO CA
94108-1608
US

V. Phone/Fax

Practice location:
  • Phone: 415-788-4292
  • Fax: 415-788-0676
Mailing address:
  • Phone: 415-788-4292
  • Fax: 415-788-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL K TONG
Title or Position: PRESIDENT
Credential: DDS
Phone: 415-788-4292