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General NPI Number Information
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NPI Number | 1285841692
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Entity Type | Organization
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Legal Business Name | TRI-VALLEY DENTAL ARTS
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9260 ALCOSTA BLVD SUITE D-30
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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Country | US
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Telephone | 925-828-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 9260 ALCOSTA BLVD SUITE D-30
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City | SAN RAMON
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State | CA
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Zip | 94583-4134
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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 | GENERAL PARTNER
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Name | RANDALL TOI
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Credential | DDS
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Telephone | 925-828-6300
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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 |
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License Number State |
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