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General NPI Number Information
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NPI Number | 1073984944
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Entity Type | Organization
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Legal Business Name | AXIS DENTAL CARE
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 34665 ALVARADO NILES RD
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City | UNION CITY
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State | CA
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Zip | 94587-4598
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Country | US
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Telephone | 510-676-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 34665 ALVARADO NILES RD
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City | UNION CITY
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State | CA
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Zip | 94587-4598
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PRERNA KULTHAM
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Credential |
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Telephone | 510-676-9035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 60638
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License Number State | CA
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