Healthcare Provider Details

I. General information

NPI: 1912098468
Provider Name (Legal Business Name): DARREN MACHULE DMD PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST STREET SUITE 1516
SAN FRANCISCO CA
94102
US

IV. Provider business mailing address

490 POST STREET SUITE 1516
SAN FRANCISCO CA
94102-1306
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-4964
  • Fax: 415-398-0147
Mailing address:
  • Phone: 415-398-4964
  • Fax: 415-398-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number43813
License Number StateCA

VIII. Authorized Official

Name: DARREN MACHULE
Title or Position: OWNER
Credential: DMD PHD
Phone: 415-398-4964