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General NPI Number Information
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NPI Number | 1154544260
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Entity Type | Organization
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Legal Business Name | CHARLES C. NIP, D.D.S., INC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 240 SHOTWELL ST SUITE 230
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-1323
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Country | US
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Telephone | 415-431-9797
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Fax | 415-431-9799
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Provider Business Mailing Address
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Address Line | 240 SHOTWELL ST SUITE 230
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-1323
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Country | US
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Telephone | 415-431-9797
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Fax | 415-431-9799
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES C. NIP
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Credential | D.D.S.
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Telephone | 415-431-9797
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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 | 20241
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License Number State | CA
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