Healthcare Provider Details

I. General information

NPI: 1952725863
Provider Name (Legal Business Name): UNIVERSITY OF THE PACIFIC ARTHUR A. DUGONI SCHOOL OF DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST ENDODONTIC CLINIC SUITE 2E
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

155 5TH ST ENDODONTIC CLINIC SUITE 2E
SAN FRANCISCO CA
94103-2919
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6501
  • Fax: 415-929-6654
Mailing address:
  • Phone: 415-929-6501
  • Fax: 415-929-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ED PEGUEROS
Title or Position: ASST DEAN, BUDGET & FIN ADMIN
Credential:
Phone: 415-351-7192