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General NPI Number Information
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NPI Number | 1316188436
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Entity Type | Organization
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Legal Business Name | KOLL CENTER DENTAL GROUP
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 6654 KOLL CENTER PKWY STE 350
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City | PLEASANTON
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State | CA
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Zip | 94566-3125
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Country | US
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Telephone | 925-484-2828
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Fax | 925-484-4504
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Provider Business Mailing Address
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Address Line | 6654 KOLL CENTER PKWY STE 350
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City | PLEASANTON
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State | CA
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Zip | 94566-3125
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Country | US
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Telephone | 925-484-2828
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Fax | 925-484-4504
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KRYSTYNE VU
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Credential |
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Telephone | 925-484-2828
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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 | 49207
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47258
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License Number State | CA
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