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General NPI Number Information
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NPI Number | 1063206274
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Entity Type | Organization
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Legal Business Name | SAN JOSE DENTISTRY & IMPLANTS
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 2453 FOREST AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-1505
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Country | US
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Telephone | 408-707-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 2453 FOREST AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-1505
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Country | US
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Telephone | 408-707-1400
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SANDRA HERNANDEZ
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Credential |
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Telephone | 831-710-7273
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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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