Healthcare Provider Details

I. General information

NPI: 1922187848
Provider Name (Legal Business Name): UCSF ORAL SURGERY CL. #20-3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

707 PARNASSUS AVE BOX 0756
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1316
  • Fax: 415-476-8999
Mailing address:
  • Phone: 415-476-1316
  • Fax: 415-476-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN D FEATHERSTONE
Title or Position: INTERIM DEAN
Credential: PHD
Phone: 415-476-8997