Healthcare Provider Details

I. General information

NPI: 1629764220
Provider Name (Legal Business Name): MAGIC TOOTH BUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 TREASURE ISLAND RD STE 206
SAN FRANCISCO CA
94130-1214
US

IV. Provider business mailing address

39 TREASURE ISLAND RD STE 206
SAN FRANCISCO CA
94130-1214
US

V. Phone/Fax

Practice location:
  • Phone: 415-580-2602
  • Fax:
Mailing address:
  • Phone: 415-580-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MA KRISELDA NERY SAYOC
Title or Position: DENTIST/ BOARD MEMBER
Credential: DMD
Phone: 520-873-8657