Healthcare Provider Details

I. General information

NPI: 1801290416
Provider Name (Legal Business Name): HILADO SUNNYVALE DENTAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2014
Last Update Date: 10/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W FREMONT AVE SUITE L
SUNNYVALE CA
94087-3021
US

IV. Provider business mailing address

990 W FREMONT AVE SUITE L
SUNNYVALE CA
94087-3021
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-9050
  • Fax: 408-739-8028
Mailing address:
  • Phone: 408-739-9050
  • Fax: 408-739-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53601
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13976
License Number StateCA

VIII. Authorized Official

Name: MS. LYNN PATRICE SANTOS
Title or Position: CFO,VP, PARTNER
Credential: R.D.H.
Phone: 408-593-5999