Healthcare Provider Details

I. General information

NPI: 1720436629
Provider Name (Legal Business Name): S.DINTCHO DDS CCM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 UNION ST
SAN FRANCISCO CA
94123-3900
US

IV. Provider business mailing address

2250 UNION ST
SAN FRANCISCO CA
94123-3900
US

V. Phone/Fax

Practice location:
  • Phone: 415-922-3886
  • Fax: 415-922-3895
Mailing address:
  • Phone: 415-922-3886
  • Fax: 415-922-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number23496
License Number StateCA

VIII. Authorized Official

Name: DR. STANLEY DINTCHO
Title or Position: PRESIDENT
Credential: DDS
Phone: 415-922-3886