=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245728666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL ARTS PRACTICE OF DR. ALBINA BATCHAEVA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2018
-----------------------------------------------------
Last Update Date | 05/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 SUTTER ST RM 1925
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-757-0604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 SUTTER ST RM 1925
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-757-0604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DENTIST
-----------------------------------------------------
Name | ALBINA BATCHAEVA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-757-0604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 62849
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------