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General NPI Number Information
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NPI Number | 1114061363
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Entity Type | Organization
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Legal Business Name | ROSE MAGNO DDS EMERYVILLE DENTAL CARE
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 6001 SHELLMOUND ST # 125
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City | EMERYVILLE
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State | CA
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Zip | 94608
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Country | US
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Telephone | 510-595-1900
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Fax | 510-594-8900
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Provider Business Mailing Address
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Address Line | PO BOX 1496
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City | ALAMEDA
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State | CA
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Zip | 94501
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Country | US
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Telephone | 510-373-5400
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Fax | 510-373-5500
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Authorized Official
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Title or Position | DENTIST
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Name | ROSE MAGNO
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Credential | DDS
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Telephone | 510-373-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42177
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License Number State | CA
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