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General NPI Number Information
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NPI Number | 1003281437
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Entity Type | Organization
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Legal Business Name | CASTRO VALLEY DENTISTRY, INC.
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 22233 REDWOOD RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-7109
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Country | US
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Telephone | 510-582-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 22233 REDWOOD RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-7109
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Country | US
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Telephone | 510-582-7122
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICK VAN TRAN
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Credential | D.D.S.
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Telephone | 510-582-7122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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