Healthcare Provider Details

I. General information

NPI: 1093880353
Provider Name (Legal Business Name): UCSF DIVISION OF ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE BOX 0438
SAN FRANCISCO CA
94143-0438
US

IV. Provider business mailing address

707 PARNASSUS AVE BOX 0438
SAN FRANCISCO CA
94143-0438
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-6707
  • Fax: 415-514-0377
Mailing address:
  • Phone: 415-502-6707
  • Fax: 415-514-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

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