Healthcare Provider Details

I. General information

NPI: 1912090945
Provider Name (Legal Business Name): UCSF BUCHANAN COMMUNITY DENTAL CENTER CL #8
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUCHANAN ST
SAN FRANCISCO CA
94102-6147
US

IV. Provider business mailing address

100 BUCHANAN ST
SAN FRANCISCO CA
94102-6147
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5608
  • Fax: 415-476-0408
Mailing address:
  • Phone: 415-476-5608
  • Fax: 415-476-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2090
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2101
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2076
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2032
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL REDDY
Title or Position: DEAN, SCHOOL OF DENTISTRY
Credential: DMD,DMSC
Phone: 415-476-1323