Healthcare Provider Details

I. General information

NPI: 1811064868
Provider Name (Legal Business Name): CAROL MARIE HREBEC DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 LOS GATOS ALMADEN RD
SAN JOSE CA
95124
US

IV. Provider business mailing address

2145 LOS GATOS ALMADEN RD
SAN JOSE CA
95124
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-9191
  • Fax: 408-377-6190
Mailing address:
  • Phone: 408-559-9191
  • Fax: 408-377-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: