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General NPI Number Information
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NPI Number | 1366093460
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Entity Type | Organization
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Legal Business Name | BR PUCAN II PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 1581 SYCAMORE AVE STE 3
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City | HERCULES
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State | CA
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Zip | 94547-1700
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Country | US
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Telephone | 510-671-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 2143 SPRINGS RD. SUITE 51
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City | VALLEJO
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State | CA
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Zip | 94591
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Country | US
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Telephone | 707-552-3952
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Fax | 707-552-9320
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | BRISBAIN RIGOR PUCAN
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Credential |
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Telephone | 707-552-3952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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