Healthcare Provider Details

I. General information

NPI: 1821173428
Provider Name (Legal Business Name): POSTGRADUATE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE SUITE D4000
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

707 PARNASSUS AVE SUITE D4000
SAN FRANCISCO CA
94143-2210
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-3546
  • Fax: 415-502-8399
Mailing address:
  • Phone: 415-514-3546
  • Fax: 415-502-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES BERTOLAMI
Title or Position: DEAN, SCHOOL OF DENTISTRY
Credential: DDS
Phone: 415-476-1323