Healthcare Provider Details

I. General information

NPI: 1336475250
Provider Name (Legal Business Name): CHRISTOPHER JON OVIEDO DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 20TH AVE STE 201
SAN FRANCISCO CA
94121-2221
US

IV. Provider business mailing address

380 20TH AVE STE 201
SAN FRANCISCO CA
94121-2221
US

V. Phone/Fax

Practice location:
  • Phone: 415-203-6875
  • Fax: 415-752-8333
Mailing address:
  • Phone: 415-203-6875
  • Fax: 415-752-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number58639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: