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General NPI Number Information
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NPI Number | 1164729422
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Entity Type | Individual
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Provider Name | MARK THOMAS BOOTH DDS
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Gender | Male
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 155 5TH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2919
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Country | US
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Telephone | 415-929-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 465 BRUSSELS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94134-1711
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Country | US
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Telephone | 415-608-1316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 49473
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License Number State | CA
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