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General NPI Number Information
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NPI Number | 1336101583
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Entity Type | Organization
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Legal Business Name | ORAL PATHOLOGY LABORATORY UCSF SCHOOL OF DENTISTRY
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 513 PARNASSUS AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94143-2205
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Country | US
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Telephone | 415-476-4868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10076
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City | VAN NUYS
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State | CA
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Zip | 91410-0076
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-8950
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD C.K. JORDAN
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Credential | DDS
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Telephone | 415-476-4868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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