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General NPI Number Information
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NPI Number | 1326318866
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Entity Type | Organization
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Legal Business Name | TIMOTHY G BRICCA
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 1201 LARKSPUR LANDING CIR STE A
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City | LARKSPUR
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State | CA
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Zip | 94939-1807
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Country | US
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Telephone | 415-461-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 LARKSPUR LANDING CIR STE A
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City | LARKSPUR
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State | CA
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Zip | 94939-1807
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Country | US
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Telephone | 415-461-6060
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TIMOTHY G BRICCA
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Credential | DDS
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Telephone | 415-461-6060
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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 | 30763
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License Number State | CA
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