Healthcare Provider Details

I. General information

NPI: 1730268657
Provider Name (Legal Business Name): UCSF SFGH MAXILLO FACIAL SURGERY CL. #20-4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE ROOM 1N1
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE ROOM 1N1
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6128
  • Fax: 415-502-0817
Mailing address:
  • Phone: 415-206-6128
  • Fax: 415-502-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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