Healthcare Provider Details

I. General information

NPI: 1720102718
Provider Name (Legal Business Name): DOUGLAS BRUCE TINLOY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VAN NESS AVE SUITE #202
SAN FRANCISCO CA
94109-3023
US

IV. Provider business mailing address

2000 VAN NESS AVE SUITE #202
SAN FRANCISCO CA
94109-3023
US

V. Phone/Fax

Practice location:
  • Phone: 415-441-1246
  • Fax: 415-441-1247
Mailing address:
  • Phone: 415-441-1246
  • Fax: 415-441-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number27566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: