Healthcare Provider Details

I. General information

NPI: 1619396918
Provider Name (Legal Business Name): DAVID WILLIAMS RISING D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE D3214
SAN FRANCISCO CA
94143-0758
US

IV. Provider business mailing address

707 PARNASSUS AVE D3214
SAN FRANCISCO CA
94143-0758
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-2459
  • Fax: 415-476-0858
Mailing address:
  • Phone: 415-514-2459
  • Fax: 415-476-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number23136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: